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Role of Screening, Monitoring in Early Kidney Disease Unclear
Date:4/17/2012

idney disease increases a person's risk of heart disease, stroke, kidney failure and death, according to the review.

The researchers searched available medical literature from 1985 through November 2011 for randomized, controlled clinical trials of people with early chronic kidney disease. A randomized controlled trial, considered the "gold standard" in research, is a study in which people are randomly assigned to receive one of several interventions.

The investigators found no trials that evaluated screening or monitoring for those with early disease, so they were unable to determine whether early detection and follow-up care would be beneficial or not.

When they searched for early chronic kidney disease treatment trials, they found 110 randomized controlled studies that included a number of treatments.

The review found that ACE inhibitors decreased the risk of end-stage renal disease by 35 percent and ARBs reduced the risk by 23 percent compared to an inactive placebo. The risk reduction was most significant for people who had signs of worsening kidney disease (macroalbuminuria).

The researchers also found evidence that ACE inhibitors lowered the risk of death by 21 percent compared to placebo in people who had more serious kidney disease, cardiovascular disease and poorly controlled diabetes.

"The risk of people with mild chronic kidney disease developing end-stage renal disease is very low, so it may be that these medications have a unique benefit in people with worse chronic kidney disease, or it may be that you just don't have enough statistical power in these trials to see the benefits in people with milder chronic kidney disease," explained Fink.

ACE inhibitors include: captopril (Capoten), enalapril (Vasotec), ramipril (Altace) and quinapril (Accupril). ARBs include: candesartan (Atacand), valsartan (Diovan), losartan (Cozaar) and olmesartan (Benicar).

Other blood pressure-lowering medications didn't
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