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Kidney Week

Abstract: FR-PO903

Renin-Angiotensin Aldosterone System Blockade in Patients With Advanced CKD: A Systematic Review and Meta-Analysis

Session Information

Category: CKD (Non-Dialysis)

  • 2201 CKD (Non-Dialysis): Epidemiology‚ Risk Factors‚ and Prevention


  • Vendeville, Nicolas, McGill University, Montreal, Quebec, Canada
  • Lepage, Marc-Antoine, McGill University, Montreal, Quebec, Canada
  • Mavrakanas, Thomas, McGill University, Montreal, Quebec, Canada

The benefits of renin-angiotensin aldosterone system (RAAS) blockers are not well-established in patients with advanced chronic kidney disease (CKD). These patients may be more sensitive to the functional decrease in glomerular filtration rate (GFR) and increased risk of hyperkalemia that are inherent to RAAS blockade. We conducted a systematic review and meta-analysis to identify potential risks and benefits of RAAS blockade in patients with CKD stage 4-5.


A Medline search was conducted to identify randomized (RCTs) and observational studies with angiotensin converting enzyme inhibitors or angiotensin receptor blockers in patients with advanced CKD, defined as an estimated GFR < 30 mL/min/1.73m^2. The primary outcome was progression to end-stage renal disease (ESRD). Secondary outcomes included all cause mortality and major adverse cardiovascular events (MACE). The risk ratio (RR) was estimated using a random-effects model.


Eight RCTs (739 patients) and 13 observational studies (59,580 patients) were included. RCTs showed significant reduction in progression to ESRD with the use of RAAS blockade: RR 0.69 (95% confidence interval [CI] 0.56-0.85). Observational studies were suggestive of decreased all-cause mortality with RAAS blockade: RR 0.85 (95% CI 0.78-0.94); but this finding was not reproduced in RCTs. No benefit from RAAS blockade was identified with respect to MACE among patients with advanced CKD.


RAAS blockers may be considered in patients with advanced CKD to delay progression to ESRD. However, no clear benefit was identified with RAAS blockade with regards to mortality and MACE in this population.


  • Government Support – Non-U.S.