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Conservative management of chronic kidney disease stage 5: role of angiotensin converting enzyme inhibitors

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Abstract

Background

Benefits and risks of angiotensin converting enzyme inhibitors (ACE-I) in advanced chronic kidney disease (CKD) are controversial. We tested the role of ACE-I in slowing the progression of renal damage in a real-world elderly population with CKD stage 5.

Methods

We evaluated all patients consecutively referred to our CKD stage 5 outpatient clinic from January 2002 to December 2013. Chronicity was defined as two consecutive estimated glomerular filtration rate (eGFR) measurements below 15 ml/min/1.73 m2. We retrieved parameters of interest at baseline and assessed eGFR reduction rate during follow-up. We estimated GFR by the 4-variable Modification of Diet in Renal Disease (MDRD) formula.

Results

Mean age of the 342 subjects analyzed was 72 years and eGFR 10 ml/min/1.73 m2. In the 188 patients on ACE-I at baseline, the subsequent annual rate of eGFR reduction was less than a third of that found in the 154 patients off ACE-I. Across phosphate quartiles, baseline eGFR significantly decreased while its annual reduction rate significantly increased. Of the original cohort, 60 patients (17 %) died, 201 (59 %) started dialysis and 81 (24 %) were still in conservative treatment at the end of the study. Multivariate analysis identified age, phosphate, proteinuria, baseline eGFR and its rate of progression as independent risk factors directly or inversely predictive of progression to dialysis. ACE-I use significantly reduced by 31 % the risk of dialysis.

Conclusions

Our study shows that proteinuria independently predicts further renal damage progression even in end-stage renal disease patients not yet in dialysis. In our cohort of elderly patients with very advanced CKD, ACE-I was effective in slowing down further renal damage progression.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Authors and Affiliations

  1. Nephrology Unit, Santa Maria Annunziata Hospital, via Dell’Antella 58, Bagno a Ripoli, Florence, Italy

    Pietro C. Dattolo, Pamela Gallo, Stefano Michelassi, Nunzia Paudice, Rossella Cannavò, Elena Romoli, Filippo Fani, Aris Tsalouchos, Alma Mehmetaj, Giuseppe Ferro, Sergio Sisca & Francesco Pizzarelli

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  1. Pietro C. Dattolo
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  2. Pamela Gallo
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Correspondence to Pietro C. Dattolo.

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Dattolo, P.C., Gallo, P., Michelassi, S. et al. Conservative management of chronic kidney disease stage 5: role of angiotensin converting enzyme inhibitors. J Nephrol 29, 809–815 (2016). https://doi.org/10.1007/s40620-016-0290-9

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  • DOI: https://doi.org/10.1007/s40620-016-0290-9

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