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Summaries for Patients are a service provided by Annals to help patients better understand the complicated and often mystifying language of modern medicine.
SUMMARIES FOR PATIENTS
Using a Type of Blood Pressure Medicine, Angiotensin-Converting Enzyme Inhibitors, To Prevent Worsening of Kidney Disease Unrelated to Diabetes
17 July 2001 | Volume 135 Issue 2 | Page S21
Summaries for Patients are presented for informational purposes only. These summaries are not a substitute for advice from your own medical provider. If you have questions about this material, or need medical advice about your own health or situation, please contact your physician. The summaries may be reproduced for not-for-profit educational purposes only. Any other uses must be approved by the American College of Physicians-American Society of Internal Medicine.
The summary below is from the full report titled "Angiotensin-Converting Enzyme Inhibitors and Progression of Nondiabetic Renal Disease. A Meta-Analysis of Patient-Level Data." It is in the 17 July 2001 issue of Annals of Internal Medicine (volume 135, pages 73-87). The authors are TH Jafar, CH Schmid, M Landa, I Giatras, R Toto, G Remuzzi, G Maschio, BM Brenner, A Kamper, P Zucchelli, G Becker, A Himmelmann, K Bannister, P Landais, S Shahinfar, PE de Jong, D de Zeeuw, J Lau, and AS Levey, for the ACE Inhibition in Progressive Renal Disease Study Group.
What is the problem and what is known about it so far?
Angiotensin-converting enzyme (ACE) inhibitors are a type of medication used to treat high blood pressure. The ACE inhibitors have clearly been shown to prevent worsening of kidney disease caused by diabetes. Some studies suggest that ACE inhibitors benefit nondiabetic people with kidney disease, while other studies do not. More than 350,000 people in the United States have end-stage kidney disease and require either dialysis, a procedure that filters the blood through an artificial kidney machine, several times a week, or a kidney transplant to stay alive. It is important to know whether ACE inhibitors might prevent worsening of kidney disease and keep some people from needing dialysis and transplantation.
Why did the researchers do this particular study?
To find out whether ACE inhibitors prevent worsening of kidney disease when the kidney disease is not due to diabetes.
Who was studied?
The study included 1860 patients with kidney disease but no diabetes. The patients had participated in any of 11 previous studies. In these studies, patients had been randomly assigned to treatment with ACE inhibitors, another type of blood pressure medicine, or placebo. Placebos are substances that look like the medicine but contain no active ingredients.
How was the study done?
Rather than do a new study, the researchers combined data from all patients who had participated in previous smaller studies of ACE inhibitors in nondiabetic people with kidney disease. Combining studies in this manner is a technique called patient-level meta-analysis; this type of study can help answer questions when several smaller studies have conflicting results. The researchers measured blood pressure and the amount of protein in the urine and compared the results in patients who received ACE inhibitors with those in patients who received other blood pressure medicines or placebo. Larger amounts of protein in the urine indicate worse kidney disease.
What did the researchers find?
Kidney function was better preserved in patients who received ACE inhibitors than in patients who received other drugs or placebos. Patients who received ACE inhibitors also had greater decreases in both blood pressure and urine protein levels. However, better blood pressure control and lower urine protein levels in the people taking ACE inhibitors did not explain the kidney benefits.
What were the limitations of the study?
Patients were followed for an average of just over 2 years, so it is not known whether the benefit from ACE inhibitors is greater or smaller after longer periods of treatment. The study does not tell us whether ACE inhibitors benefit persons who have very mild kidney disease and no protein in the urine.
What are the implications of the study?
Angiotensin-converting enzyme inhibitors help prevent worsening of kidney disease that is unrelated to diabetes.
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A. Schieppati and G. Remuzzi Fighting Renal Diseases in Poor Countries: Building a Global Fund with the Help of the Pharmaceutical Industry J. Am. Soc. Nephrol., March 1, 2004; 15(3): 704 - 707. [Abstract] [Full Text] [PDF]
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R. Pontremoli, G. Leoncini, F. Viazzi, D. Parodi, E. Ratto, S. Vettoretti, M. Ravera, C. Tomolillo, and G. Deferrari Cardiovascular and Renal Risk Assessment as a Guide for Treatment in Primary Hypertension J. Am. Soc. Nephrol., January 1, 2004; 15(90010): S34 - 36. [Abstract] [Full Text]
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T. Berl Angiotensin-Converting Enzyme Inhibitors versus AT1 Receptor Antagonist in Cardiovascular and Renal Protection: The case for AT1 Receptor Antagonist J. Am. Soc. Nephrol., January 1, 2004; 15(90010): S71 - 76. [Abstract] [Full Text]
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H. V. Anderson Angiotensin-converting enzyme inhibitors: ischemia is not the correct measure of benefit J. Am. Coll. Cardiol., December 17, 2003; 42(12): 2060 - 2062. [Full Text] [PDF]
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L. E. Boulware, B. G. Jaar, M. E. Tarver-Carr, F. L. Brancati, and N. R. Powe Screening for Proteinuria in US Adults: A Cost-effectiveness Analysis JAMA, December 17, 2003; 290(23): 3101 - 3114. [Abstract] [Full Text] [PDF]
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W. A. Wilmer, B. H. Rovin, C. J. Hebert, S. V. Rao, K. Kumor, and L. A. Hebert Management of Glomerular Proteinuria: A Commentary J. Am. Soc. Nephrol., December 1, 2003; 14(12): 3217 - 3232. [Abstract] [Full Text] [PDF]
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A. V. Chobanian, G. L. Bakris, H. R. Black, W. C. Cushman, L. A. Green, J. L. Izzo Jr, D. W. Jones, B. J. Materson, S. Oparil, J. T. Wright Jr, et al. Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure Hypertension, December 1, 2003; 42(6): 1206 - 1252. [Abstract] [Full Text] [PDF]
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M. K. Haroun, B. G. Jaar, S. C. Hoffman, G. W. Comstock, M. J. Klag, and J. Coresh Risk Factors for Chronic Kidney Disease: A Prospective Study of 23,534 Men and Women in Washington County, Maryland J. Am. Soc. Nephrol., November 1, 2003; 14(11): 2934 - 2941. [Abstract] [Full Text] [PDF]
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Minerva BMJ, October 6, 2003; 327(7418): E66 - 66. [Full Text] [PDF]
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T. H. Jafar, C. H. Schmid, P. C. Stark, R. Toto, G. Remuzzi, P. Ruggenenti, C. Marcantoni, G. Becker, S. Shahinfar, P. E. de Jong, et al. The rate of progression of renal disease may not be slower in women compared with men: a patient-level meta-analysis Nephrol. Dial. Transplant., October 1, 2003; 18(10): 2047 - 2053. [Abstract] [Full Text] [PDF]
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A. V. Crowe, M. Howse, S. Vinjamuri, G. J. Kemp, and P. S. Williams The antiproteinuric effect of losartan is systemic blood pressure dependent Nephrol. Dial. Transplant., October 1, 2003; 18(10): 2160 - 2164. [Abstract] [Full Text] [PDF]
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W. J Weise Combination ACE inhibitor and angiotensin receptor blocker therapy was better than monotherapy in non-diabetic renal disease Evid. Based Med., September 1, 2003; 8(5): 143 - 143. [Full Text] [PDF]
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T. H. Jafar, P. C. Stark, C. H. Schmid, M. Landa, G. Maschio, P. E. de Jong, D. de Zeeuw, S. Shahinfar, R. Toto, A. S. Levey, et al. Progression of Chronic Kidney Disease: The Role of Blood Pressure Control, Proteinuria, and Angiotensin-Converting Enzyme Inhibition: A Patient-Level Meta-Analysis Ann Intern Med, August 19, 2003; 139(4): 244 - 252. [Abstract] [Full Text] [PDF]
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C. D. Mulrow and R. R. Townsend Guiding Lights for Antihypertensive Treatment in Patients with Nondiabetic Chronic Renal Disease: Proteinuria and Blood Pressure Levels? Ann Intern Med, August 19, 2003; 139(4): 296 - 298. [Full Text] [PDF]
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G. L. Bakris, M. R. Weir, S. Shanifar, Z. Zhang, J. Douglas, D. J. van Dijk, and B. M. Brenner Effects of Blood Pressure Level on Progression of Diabetic Nephropathy: Results From the RENAAL Study Arch Intern Med, July 14, 2003; 163(13): 1555 - 1565. [Abstract] [Full Text] [PDF]
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S. J. Chadban, E. M. Briganti, P. G. Kerr, D. W. Dunstan, T. A. Welborn, P. Z. Zimmet, and R. C. Atkins Prevalence of Kidney Damage in Australian Adults: The AusDiab Kidney Study J. Am. Soc. Nephrol., July 1, 2003; 14(90002): S131 - 138. [Abstract] [Full Text] [PDF]
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M. Praga, E. Gutierrez, E. Gonzalez, E. Morales, and E. Hernandez Treatment of IgA Nephropathy with ACE Inhibitors: A Randomized and Controlled Trial J. Am. Soc. Nephrol., June 1, 2003; 14(6): 1578 - 1583. [Abstract] [Full Text] [PDF]
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E. D. Frohlich Treating Hypertension -- What Are We to Believe? N. Engl. J. Med., February 13, 2003; 348(7): 639 - 641. [Full Text] [PDF]
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P. Ruggenenti, N. Mise, R. Pisoni, F. Arnoldi, A. Pezzotta, A. Perna, D. Cattaneo, and G. Remuzzi Diverse Effects of Increasing Lisinopril Doses on Lipid Abnormalities in Chronic Nephropathies Circulation, February 4, 2003; 107(4): 586 - 592. [Abstract] [Full Text] [PDF]
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The ALLHAT Officers and Coordinators for the ALLHA Major Outcomes in High-Risk Hypertensive Patients Randomized to Angiotensin-Converting Enzyme Inhibitor or Calcium Channel Blocker vs Diuretic: The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) JAMA, December 18, 2002; 288(23): 2981 - 2997. [Abstract] [Full Text] [PDF]
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L. J. Appel The Verdict From ALLHAT--Thiazide Diuretics Are the Preferred Initial Therapy for Hypertension JAMA, December 18, 2002; 288(23): 3039 - 3042. [Full Text] [PDF]
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G. D Laverman, D. de Zeeuw, and G. Navis Between-patient differences in the renal response to renin-angiotensin system intervention: clue to optimising renoprotective therapy? Journal of Renin-Angiotensin-Aldosterone System, December 1, 2002; 3(4): 205 - 213. [Abstract] [PDF]
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 J. Cheng and J. P. Grande Transforming Growth Factor-{beta} Signal Transduction and Progressive Renal Disease Experimental Biology and Medicine, December 1, 2002; 227(11): 943 - 956. [Abstract] [Full Text]
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T. H. Hostetter The Next Treatments of Chronic Kidney Disease: If We Find Them, Can We Test Them? J. Am. Soc. Nephrol., December 1, 2002; 13(12): 3024 - 3026. [Full Text] [PDF]
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J. T. Wright Jr, G. Bakris, T. Greene, L. Y. Agodoa, L. J. Appel, J. Charleston, D. Cheek, J. G. Douglas-Baltimore, J. Gassman, R. Glassock, et al. Effect of Blood Pressure Lowering and Antihypertensive Drug Class on Progression of Hypertensive Kidney Disease: Results From the AASK Trial JAMA, November 20, 2002; 288(19): 2421 - 2431. [Abstract] [Full Text] [PDF]
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