Inhibitors of the renin-angiotensin system (ACE inhibitors and ARBs) more effectively reduce proteinuria and slow progression to ESRD than non-RAS inhibitor therapy at comparable BP control.
Do RAS inhibitors reduce proteinuria and slow progression to ESRD in patients with CKD compared to non-RAS inhibitor therapy?
RAS inhibitors are effective in reducing proteinuria and slowing CKD progression, particularly in diabetic patients, though multimodal approaches are often required for optimal risk factor control.
As CKD continues to increase worldwide, along with the demand for related life-saving therapies, the financial burden of CKD will place an increasing drain on health care systems. Experimental studies showed that glomerular capillary hypertension and impaired sieving function with consequent protein overload play a pathogenic role in the progression of CKD. Consistently, human studies show that proteinuria is an independent predictor of progression and that its reduction is renoprotective. At comparable BP control, inhibitors of the renin-angiotensin system (RAS), including angiotensin converting enzyme (ACE) inhibitors and angiotensin II receptor blockers (ARBs), more effectively than non-RAS inhibitor therapy reduce proteinuria, slow progression to ESRD, and even improve the kidney function achieving disease regression in some cases. In participants with diabetes, RAS inhibitors delay the onset of microalbuminuria and its progression to macroalbuminuria, and ACE inhibitors may reduce the excess cardiovascular mortality associated with diabetic renal disease. In addition to RAS inhibitors, however, multimodal approaches including lifestyle modifications and multidrug therapy will be required in most cases to optimize control of the several risk factors for CKD and related cardiovascular morbidity. Whether novel medications may help further improve the cost-effectiveness of renoprotective interventions is a matter of investigation.
Ruggenenti et al. (Fri,) conducted a review in Chronic Kidney Disease (CKD). Renin-angiotensin system (RAS) inhibitors vs. Non-RAS inhibitor therapy was evaluated. Inhibitors of the renin-angiotensin system (ACE inhibitors and ARBs) more effectively reduce proteinuria and slow progression to ESRD than non-RAS inhibitor therapy at comparable BP control.
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