Management of Chronic Kidney Disease Stages 1–3
Clinical Bottom Line: Risk for ESRD in Patients With CKD Stages 1–3 Treated With ARBs
In randomized controlled trials of patients with CKD stages 1–3, several treatments reduced the risk of clinical outcomes, but the benefits appeared to be limited to specific CKD subgroups, some of whom already had a clinical indication for the treatment studied. When compared with placebo, ARBs reduced the risk of ESRD by 22 percent but only among patients with overt proteinuria, most of whom had diabetes and hypertension (RR 0.78, 95% CI, 0.67-0.90; 3 trials, n = 4,652; high strength of evidence). ESRD was not significantly reduced in patients with CKD stages 1–3 who did not have proteinuria. Patients with proteinuria, diabetes, and hypertension may benefit from ACEI or ARB treatment.
95% CI = 95-percent confidence interval; ARB = angiotensin II receptor blocker; ARR = absolute risk reduction; CKD = chronic kidney disease; ESRD = end-stage renal disease; RR = risk ratio
Keywords: chronic kidney disease | treatment | angiotensin receptor blocker | ARB | macroalbuminuria | diabetes | hypertension
- Fink HA, Ishani A, Taylor BC, et al. Chronic Kidney Disease Stages 1–3: Screening, Monitoring, and Treatment. Comparative Effectiveness Review No. 37 (Prepared by the Minnesota Evidence-based Practice Center under Contract No. HHSA 290-2007-10064-I). Rockville, MD: Agency for Healthcare Research and Quality; January 2012. AHRQ Publication No. 11(12)-EHC075-EF. Available at www.effectivehealthcare.ahrq.gov/ckd.cfm.
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