Evidence mapPaperPMID 38950402Full record

SynthesisAnnals of internal medicine2024

Angiotensin-Converting Enzyme Inhibitors or Angiotensin-Receptor Blockers for Advanced Chronic Kidney Disease : A Systematic Review and Retrospective Individual Participant-Level Meta-analysis of Clinical Trials.

Elaine Ku, Lesley A Inker, Hocine Tighiouart, Charles E McCulloch, Ogechi M Adingwupu, Tom Greene, Raymond O Estacio, Mark Woodward, Dick de Zeeuw, Julia B Lewis and 9 more

Abstract readMeta-AnalysisSystematic Review
In one paragraph

Synthesis in Annals of internal medicine, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 30 papers, 2 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
30citing papers in PubMed, 2 pooled it
field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

30 citing papers in PubMed, 2 syntheses or guidelines pooled it.

  1. Guideline
  2. Pooled it
  3. Review
  4. Review
  5. Article
  6. Review
  7. Review
  8. Review
  9. Ketone Body Supplementation Exerts Renoprotective Effects Against Adenine-Induced Kidney Injury via OXCT1-Mediated Ketolysis in Mice.FASEB journal : official publication of the Federation of American Societies for Experimental Biology · 2026
    Article
  10. Review
  11. Review
  12. Observational
  13. Article
  14. Review
  15. Review
  16. Article
  17. Review
  18. Frontiers in pharmacology · 2026
    Article
  19. Article
  20. Pillar Risk-Based Treatment for Chronic Kidney Disease in People With Type 2 Diabetes: A Narrative Review.Diabetes therapy : research, treatment and education of diabetes and related disorders · 2025
    Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

19 authors.

Elaine KuDepartments of Medicine and Pediatrics, Division of Nephrology, and Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California (E.K.).ORCID 0000-0002-7774-2526
Lesley A InkerDepartment of Medicine, Division of Nephrology, Tufts Medical Center, Boston, Massachusetts (L.A.I., O.M.A., M.J.S.).
Hocine TighiouartInstitute for Clinical Research and Health Policy Studies, Tufts Medical Center, and Tufts Clinical and Translational Science Institute, Tufts University, Boston, Massachusetts (H.T.).ORCID 0000-0003-1448-327X
Charles E McCullochDepartment of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California (C.E.M.).
Ogechi M AdingwupuDepartment of Medicine, Division of Nephrology, Tufts Medical Center, Boston, Massachusetts (L.A.I., O.M.A., M.J.S.).ORCID 0009-0003-7475-4171
Tom GreenePopulation Health Sciences, University of Utah School of Medicine, Salt Lake City, Utah (T.G.).
Raymond O EstacioAmbulatory Care Services, Denver Health, and Department of General Internal Medicine, University of Colorado at Denver, Health Sciences Center, Denver, Colorado (R.O.E.).
Mark WoodwardThe George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia, and The George Institute for Global Health, School of Public Health, Imperial College London, London, United Kingdom (M.W.).ORCID 0000-0001-9800-5296
Dick de ZeeuwClinical Pharmacy and Pharmacology, University Medical Center Groningen, Groningen, the Netherlands (D.deZ.).ORCID 0000-0003-3434-7777
Julia B LewisDivision of Nephrology, Vanderbilt University Medical Center, Nashville, Tennessee (J.B.L.).ORCID 0000-0002-1530-7115
Thierry HannedoucheUniversity of Strasbourg, AURAL, Strasbourg, France (T.H.).ORCID 0000-0002-8493-8260
Tazeen H JafarProgram in Health Services and Systems Research, Duke-NUS Medical School, Singapore (T.H.J.).ORCID 0000-0001-7454-8376
Enyu ImaiNakayamadera Imai Clinic, Takarazuka, Japan (E.I.).
Giuseppe RemuzziIstituto di Ricerche Farmacologiche Mario Negri IRCCS, Bergamo, Italy (G.R.).ORCID 0000-0002-6194-3446
Hiddo J L HeerspinkDepartment of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands (H.J.L.H.).ORCID 0000-0002-3126-3730
Fan Fan HouDivision of Nephrology, Nanfang Hospital, Southern Medical University, National Clinical Research Center for Kidney Disease, Guangzhou, China (F.F.H.).ORCID 0000-0003-3117-7418
Robert D TotoUniversity of Texas Southwestern Medical Center, Dallas, Texas (R.D.T.).ORCID 0000-0001-9531-1749
Philip K LiDepartment of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China (P.K.L.).ORCID 0000-0001-9879-8388
Mark J SarnakDepartment of Medicine, Division of Nephrology, Tufts Medical Center, Boston, Massachusetts (L.A.I., O.M.A., M.J.S.).ORCID 0000-0002-2457-6368

Funding

NIDDK NIH HHS R01 DK121904
6 · The paper itself

Abstract

backgroundIn patients with advanced chronic kidney disease (CKD), the effects of initiating treatment with an angiotensin-converting enzyme inhibitor (ACEi) or angiotensin-receptor blocker (ARB) on the risk for kidney failure with replacement therapy (KFRT) and death remain unclear. PURPOSE: To examine the association of ACEi or ARB treatment initiation, relative to a non-ACEi or ARB comparator, with rates of KFRT and death. DATA SOURCES: Ovid Medline and the Chronic Kidney Disease Epidemiology Collaboration Clinical Trials Consortium from 1946 through 31 December 2023. STUDY SELECTION: Completed randomized controlled trials testing either an ACEi or an ARB versus a comparator (placebo or antihypertensive drugs other than ACEi or ARB) that included patients with a baseline estimated glomerular filtration rate (eGFR) below 30 mL/min/1.73 m DATA EXTRACTION: The primary outcome was KFRT, and the secondary outcome was death before KFRT. Analyses were done using Cox proportional hazards models according to the intention-to-treat principle. Prespecified subgroup analyses were done according to baseline age (<65 vs. ≥65 years), eGFR (<20 vs. ≥20 mL/min/1.73 m DATA SYNTHESIS: A total of 1739 participants from 18 trials were included, with a mean age of 54.9 years and mean eGFR of 22.2 mL/min/1.73 m LIMITATION: Individual participant-level data for hyperkalemia or acute kidney injury were not available.

conclusionInitiation of ACEi or ARB therapy protects against KFRT, but not death, in people with advanced CKD. PRIMARY FUNDING SOURCE: National Institutes of Health. (PROSPERO: CRD42022307589).

Indexed as

Angiotensin-Converting Enzyme InhibitorsAngiotensin Receptor AntagonistsRenal Insufficiency, ChronicGlomerular Filtration RateHumansRandomized Controlled Trials as TopicRenal Replacement TherapyRetrospective StudiesAngiotensin-Converting Enzyme InhibitorsAngiotensin Receptor Antagonists

Identifiers

PMID38950402
PMCPMC12519637

What Socratic holds

Textmetadata
LicenceTDM
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.