Key result
RAAS blockade reduces progression to ESKD by ~16% in advanced chronic kidney disease.
Why the study?
The cardiovascular and renal benefits of RAAS blockade are not well established in patients with advanced CKD (stage 4-5).
Does RAAS blockade reduce progression to ESKD in patients with advanced CKD stage 4-5?
Meta-Analysis (n=1,150)
Does RAAS blockade reduce progression to ESKD in patients with advanced CKD stage 4-5?
Relative Risk: 0.84 (95% CI 0.74–0.96)
p-value: p=0.01
RAAS blockade significantly reduces the risk of progression to end-stage kidney disease in patients with advanced CKD stage 4-5, though it does not significantly impact mortality or MACE.
RAAS blockade may delay ESKD progression in selected advanced CKD patients; extends RCT evidence to stage 4-5 without mortality or MACE benefit.
BACKGROUND: The cardiovascular and renal benefits of renin-angiotensin aldosterone system (RAAS) blockade are not well established in patients with advanced chronic kidney disease (CKD). We conducted a systematic review and meta-analysis to identify potential risks and benefits from RAAS blockade in patients with CKD stage 4-5. METHODS: ) comparing RAAS blockade vs placebo or alternative antihypertensive therapy. Different intervention strategies were assessed (RAAS use vs nonuse, initiation vs placebo/alternative therapy, or discontinuation vs continuation). The primary outcome was progression to end-stage kidney disease (ESKD). Secondary outcomes were all-cause mortality and major adverse cardiovascular events (MACE). The risk ratio (RR) was estimated with the use of a random-effects model. RESULTS: Nine RCTs (1150 patients) were included. RAAS blockade was associated with a significant reduction in progression to ESKD: RR 0.84 (95% confidence interval [CI] 0.74-0.96; P = 0.01). There was no benefit from RAAS blockade on all-cause mortality or MACE: RR 1.02 (95% CI 0.63-1.65; P = 0.93) and RR 0.87 (95% CI 0.49-1.57; P = 0.65), respectively. CONCLUSIONS: RAAS blockade may be considered in selected patients with CKD stage 4-5 to delay progression to ESKD.
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Vendeville et al. (2024) conducted a meta-analysis in Advanced chronic kidney disease (CKD stage 4-5) (n=1,150). Renin-angiotensin aldosterone system (RAAS) blockade vs. Placebo or alternative antihypertensive therapy was evaluated on Progression to end-stage kidney disease (ESKD) (RR 0.84, 95% CI 0.74-0.96, p=0.01). RAAS blockade significantly reduced progression to end-stage kidney disease in patients with advanced chronic kidney disease (RR 0.84; 95% CI 0.74-0.96; P=0.01).
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