What is the benefit of treatment with ACE inhibitors or ARBs in advanced chronic kidney disease (CKD) and stable hypertension?

Updated: Jul 21, 2021
  • Author: Pradeep Arora, MD; Chief Editor: Vecihi Batuman, MD, FASN  more...
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A prospective cohort study indicated that in patients with advanced CKD and stable hypertension, antihypertensive treatment with ACEIs or ARBs reduces the likelihood of long-term dialysis and lowers the mortality risk as well. [54, 55]

The study involved 28,497 predialysis patients with advanced CKD, hypertension, and anemia. Based on a median follow-up period of 7 months, the investigators found that in those patients who were treated with ACEIs or ARBs, the need for long-term dialysis was 6% lower than in patients who were not treated with these drugs, with the composite outcome of long-term dialysis or death also being 6% lower.

The rate of hyperkalemia-associated hospitalization was higher in the ACEI/ARB patients, but no significant increase was found in hyperkalemia-related predialysis mortality.

A retrospective simulation study found that in older patients with CKD, ACEIs and ARBs provided only marginal benefit in preventing progression to end-stage renal disease (ESRD). Among over 370,000 CKD patients aged 70 years and older, the number needed to treat (NNT) to prevent 1 case of ESRD was more than 100 for most patients (even with an exposure time of > 10 y). In younger patients, the the NNT ranged from 9-25. The investigators suggested that the reduced benefits  in older patients may reflect differences in baseline risk and life expectancy between older and younger patients. [56, 56]

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