Renin-Angiotensin System Inhibitors in Patients with Advanced Kidney Disease

Renin-angiotensin system (RAS) inhibitors are preferred over other antihypertensive agents to slow progression of chronic kidney disease (CKD), but patients with advanced CKD have not been studied extensively. In this report, researchers used a Swedish national renal registry to fill this gap. They identified nearly 5000 nondialyzed patients with estimated glomerular filtration rate <30 mL/minute/1.73 m² in whom either a RAS inhibitor (i.e., an angiotensin-converting–enzyme inhibitor or an angiotensin-receptor blocker) or a calcium-channel blocker (CCB) was initiated. With propensity-score weighting, the RAS inhibitor and CCB groups were closely matched in clinical characteristics.

During median follow-up of 4 years, users of RAS inhibitors …