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The effect of angiotensin-converting-enzyme inhibitors on progression of advanced polycystic kidney disease.

Publication ,  Journal Article
Jafar, TH; Stark, PC; Schmid, CH; Strandgaard, S; Kamper, A-L; Maschio, G; Becker, G; Perrone, RD; Levey, AS ...
Published in: Kidney international
January 2005

It is not known whether angiotensin-converting-enzyme (ACE) inhibitors slow the progression of polycystic kidney disease (PKD). We performed a patient-level meta-analysis to compare the effect of antihypertensive regimens, including ACE inhibitors, to those without ACE inhibitors (controls) on kidney disease progression in patients with PKD.We analyzed a database of 11 randomized controlled trials including 1860 patients with nondiabetic kidney disease. We compared randomized groups for the decline in urine protein excretion and kidney disease progression (combined outcome of doubling of baseline serum creatinine or onset of kidney failure). We also performed multivariable linear regression and Cox proportional hazards analyses. Based on previous findings, we searched for interactions between the treatment effect (effect of ACE inhibitors vs. controls) and baseline urine protein excretion in both models.Eight studies included a total of 142 subjects with PKD: 68 (48%) were randomized to ACE inhibitors and 74 (52%) were randomized to the control. Baseline mean (SD) urine protein excretion was 0.92 (1.40) g/day: 1.08 (1.50) g/day in the ACE inhibitor and 0.76 (1.28) g/day in the control group. During a mean follow-up of 2.3 years, mean (SD) urine protein excretion declined by 0.33 (1.11) g/day in the ACE inhibitor group and increased by 0.19 (0.88) g/day in the control group (P < 0.001). Kidney disease progression occurred in 50 patients: 20 patients (29%) in the ACE inhibitor group and 30 patients (41%) in the control group (P= 0.17). ACE inhibitors had a greater effect on lowering urine protein excretion and slowing kidney disease progression in patients with higher levels of baseline urine protein excretion (interaction P < 0.001 and P= 0.03, respectively).As in other causes of non-diabetic kidney disease, antihypertensive regimens with ACE inhibitors are more effective in lowering urine protein excretion in patients with advanced PKD compared to regimens without ACE inhibitors, and this benefit is greater in patients with higher levels of baseline urine protein excretion. The effect of ACE inhibitors to slow kidney disease progression in PKD is inconclusive.

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Published In

Kidney international

DOI

EISSN

1523-1755

ISSN

0085-2538

Publication Date

January 2005

Volume

67

Issue

1

Start / End Page

265 / 271

Related Subject Headings

  • Urology & Nephrology
  • Proteinuria
  • Proportional Hazards Models
  • Polycystic Kidney Diseases
  • Multivariate Analysis
  • Humans
  • Databases, Factual
  • Blood Pressure
  • Angiotensin-Converting Enzyme Inhibitors
  • 3202 Clinical sciences
 

Citation

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Jafar, T. H., Stark, P. C., Schmid, C. H., Strandgaard, S., Kamper, A.-L., Maschio, G., … ACE Inhibition in Progressive Renal Disease (AIPRD) Study Group, . (2005). The effect of angiotensin-converting-enzyme inhibitors on progression of advanced polycystic kidney disease. Kidney International, 67(1), 265–271. https://doi.org/10.1111/j.1523-1755.2005.00077.x
Jafar, Tazeen H., Paul C. Stark, Christopher H. Schmid, Svend Strandgaard, Anne-Lise Kamper, Giuseppe Maschio, Gavin Becker, Ronald D. Perrone, Andrew S. Levey, and Andrew S. ACE Inhibition in Progressive Renal Disease (AIPRD) Study Group. “The effect of angiotensin-converting-enzyme inhibitors on progression of advanced polycystic kidney disease.Kidney International 67, no. 1 (January 2005): 265–71. https://doi.org/10.1111/j.1523-1755.2005.00077.x.
Jafar TH, Stark PC, Schmid CH, Strandgaard S, Kamper A-L, Maschio G, et al. The effect of angiotensin-converting-enzyme inhibitors on progression of advanced polycystic kidney disease. Kidney international. 2005 Jan;67(1):265–71.
Jafar, Tazeen H., et al. “The effect of angiotensin-converting-enzyme inhibitors on progression of advanced polycystic kidney disease.Kidney International, vol. 67, no. 1, Jan. 2005, pp. 265–71. Epmc, doi:10.1111/j.1523-1755.2005.00077.x.
Jafar TH, Stark PC, Schmid CH, Strandgaard S, Kamper A-L, Maschio G, Becker G, Perrone RD, Levey AS, ACE Inhibition in Progressive Renal Disease (AIPRD) Study Group. The effect of angiotensin-converting-enzyme inhibitors on progression of advanced polycystic kidney disease. Kidney international. 2005 Jan;67(1):265–271.
Journal cover image

Published In

Kidney international

DOI

EISSN

1523-1755

ISSN

0085-2538

Publication Date

January 2005

Volume

67

Issue

1

Start / End Page

265 / 271

Related Subject Headings

  • Urology & Nephrology
  • Proteinuria
  • Proportional Hazards Models
  • Polycystic Kidney Diseases
  • Multivariate Analysis
  • Humans
  • Databases, Factual
  • Blood Pressure
  • Angiotensin-Converting Enzyme Inhibitors
  • 3202 Clinical sciences