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Management of Chronic Kidney Disease Stages 1–3

Slide: 13 of 29

Clinical Bottom Line: Risk for ESRD in Patients With CKD Stages 1–3 Treated With ACEIs

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 which already had a clinical indication for the treatment studied. When compared to placebo, ACEIs reduced the risk of ESRD overall, but this benefit appeared to be present only among patients with overt proteinuria (macroalbuminuria), most of whom had diabetes and hypertension (RR 0.60, 95% CI, 0.43–0.83; 3 trials, n = 861; moderate strength of evidence). In patients with CKD stages 1–3 with only microalbuminuria or impaired eGFR, ACEIs did not reduce the risk for ESRD when compared with a placebo, but these trials were not powered to detect a treatment-related difference in risk for progression to ESRD (these results were not given a strength of evidence rating).

Abbreviations:
95% CI = 95-percent confidence interval; ACEI = angiotensin-converting enzyme inhibitor; ARR = absolute risk reduction; CKD = chronic kidney disease; eGFR = estimated glomerular filtration rate; ESRD = end-stage renal disease; RR = risk ratio