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ASN leads the fight to prevent, treat, and cure kidney diseases throughout the world by educating health professionals and scientists, advancing research and innovation, communicating new knowledge, and advocating for the highest quality care for patients.

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Kidney Week

Abstract: PO0442

Renin-Angiotensin-Aldosterone System (RAAS) Blockade Does Not Affect Kidney Progression in Patients with CKD Without Diabetes and Without Proteinuria

Session Information

Category: CKD (Non-Dialysis)

  • 2101 CKD (Non-Dialysis): Epidemiology, Risk Factors, and Prevention


  • Chang, Shirley Shwu-Shiow, Erie County Medical Center, Buffalo, New York, United States
  • Jalal, Kabir, University at Buffalo - The State University of New York, Buffalo, New York, United States
  • Charest, Andre F., Erie County Medical Center, Buffalo, New York, United States

Non-proteinuric CKD contributes to about 80% of end stage kidney disease and is poorly studied in terms of risk factors & pathogenesis. RAAS blockers such as angiotensin-converting enzyme inhibitors (ACEI) and angiotensin receptor blockers (ARB) have been shown to be renoprotective in CKD progression in patients with diabetes and proteinuria. There is a paucity of data on effect of ACEI/ARB in non-diabetic non-proteinuric CKD patients.


This is a retrospective observational study of insurance claim database from 1/1/07 to 12/31/17 examining the effect of ACEI or ARB use on CKD progression. Inclusion criteria: adults at least 18 years of age, with CKD stage 3 or higher [based on at least 2 serum creatinine (SCr) values 90 days apart] with at least 2 urinalyses with dipstick urine protein with negative or trace, follow-up (FU) period of at least 3 yrs. Patients with diabetes or proteinuria were excluded. Primary outcomes were doubling of SCr, or reaching CKD stage 5. Mortality data was not available. Duration of ACEI/ARB exposure is defined as number of prescribed days. The eGFR was calculated based on CKD-EPI equation. Analysis are performed with 2 models: time varying Cox regression, and mixed model (which included time-period fixed effect and random effects). A greedy 1:1 propensity score matching scheme was applied.


Of 20,000 CKD patients, there were 2,853 with CKD stage 3 or higher without proteinuria, with 301 on ACEI/ARB during mean FU 6 yrs. Percentage of patients with HTN or CHF, mean age, gender, and eGFR did not differ between ACEI/ARB vs. non-ACEI/ARB groups. The eGFR decrease per year was not statistically different between those on ACEI/ARB vs. non-ACEI/ARB group (matched cox model, p = 0.2285; mixed model, p = 0.4346 respectively). Age and ACEI/ARB duration of exposure have no effect. ACEI/ARB patients had lower rate of developing diabetes during the study (OR 0.57, p = 0.0044), and higher rate of proteinuria at the end of study (OR 1.59, p = 0.0048), though these associations were not observed in the matched sample.


This study suggests ACEI/ARB does not affect CKD progression in non-diabetic & non-proteinuric patients, irrespective of age. Further studies are needed to confirm those findings.