Randomized Controlled Trial of Treatment of Chronic Kidney Disease of Uncertain Aetiolgy with Enalapril

Introduction: A double blind placebo controlled randomized trial was conducted to investigate the effect of angiotensin-converting-enzyme (ACE) inhibitor enalapril on the progression of Chronic Kidney Disease (CKD) caused by chronic exposure to nephrotoxins. Methods: 263 people aged 18-70 years diagnosed with CKD stages I, II or III who were not taking ACE inhibitors, who had no other chronic disease or contraindication for treatment with ACE inhibitors, were randomly assigned to enalapril or placebo. The main outcomes were albumin to creatinine ratio (ACR) and estimated glomerular filtration rate (eGFR). Results: The mean systolic and diastolic blood pressure levels declined significantly in both enalapril and placebo groups with no significant difference in the two groups. There was a significant improvement in the albumin to creatinine ratio in the enalapril group compared to the placebo group (p<0.005). In the enalapril group, the mean albumin to creatinine ratio declined from 162.0 mg/g (SD 321.7) at baseline, to 55.4 mg/g (SD 122.4) at one year follow up; while in the placebo group, the mean albumin to creatinine ratio increased from 197.9 mg/g (SD 461.6) at baseline to 253.2 mg/g (SD 558.7), at one year follow up. In both groups, the eGFR declined significantly, during the 12 month follow-up, lower in the enalapril group, although with no significant difference. In the enalapril group the mean (eGFR) declined from 71.7 ml/min (SD 22.2) to 57.1 ml/min (SD16.1), while in the placebo group the mean eGFR declined from 73.8 ml/min (SD 24.2) to 54.7 ml/min (SD 20.3). Conclusion: Enalapril is beneficial in reducing albuminuria in patients with chronic kidney disease of uncertain aetiology.