Effect of ACE inhibitors in diabetic and nondiabetic chronic renal disease: A systematic overview of randomized placebo-controlled trials

Clinical trials have shown the beneficial effects of angiotensin-converting enzyme (ACE) inhibitors in delaying the progression of diabetic renal dise ase. There is less evidence from primary clinical trials of nondiabetic ren al disease. We performed an updated meta-analysis to determine the efficacy of ACE inhibitors in slowing the progression of renal disease over a broad range of functional renal impairment. We included published and unpublishe d randomized, placebo-controlled, parallel trials with at least 1 year of f ollow-up available from January 1970 to June 1999. In nine trials of subjec ts with diabetic nephropathy and microalbuminuria, the relative risk for de veloping macroalbuminuria was 0.35 (95% confidence interval [CI], 0.24 to 0 .53) for individuals treated with an ACE inhibitor compared with placebo. I n seven trials of subjects with overt proteinuria and renal insufficiency f rom a variety of causes (30% diabetes, 70% nondiabetes), the relative risk for doubling of serum creatinine concentration or developing end-stage rena l disease was 0.60 (95% CI, 0.49 to 0.73) for individuals treated with an A CE inhibitor compared with placebo. Treatment of individuals with chronic r enal insufficiency with ACE inhibitors delays the progression of disease co mpared with placebo across a spectrum of disease causes and renal dysfuncti on. (C) 2000 by the National Kidney Foundation, Inc.