Current Guidelines for Using Angiotensin-Converting Enzyme Inhibitors and Angiotensin II–Receptor Antagonists in Chronic Kidney Disease: Is the Evidence Base Relevant to Older Adults?
O'Hare AM et al. - The authors evaluated the relevance to adults older than 70 years of the evidence base for major U.S. practice guidelines for the use of these agents in chronic kidney disease. The authors first examined the representation of older adults in randomized trials that underpin these guidelines, then compared the characteristics of participants in these trials with those of a representative sample of older adults with chronic kidney disease in the general population. The authors found that current guidelines for the use of angiotensin-converting enzyme inhibitors and angiotensin II–receptor antagonists in chronic kidney disease are based on evidence with limited relevance to most persons older than 70 years with this condition.
- Almost one half of adults in the general population who meet criteria for chronic kidney disease are older than 70 years.
- Persons older than 70 years are underrepresented in most trials underpinning major U.S. practice guidelines for the use of angiotensin-converting enzyme (ACE) inhibitors and angiotensin II–receptor blockers (ARBs) in chronic kidney disease.
- More than 85% of persons older than 70 years who meet criteria for chronic kidney disease do not have proteinuria. The relevance of guideline trials to this group may be limited because most favored inclusion of participants with proteinuria.
- Differences between guidelines in criteria for the use of ACE inhibitors and ARBs in chronic kidney disease lead to considerable variation across guidelines in the proportion of older adults targeted.
- Practice guidelines specifically recommend the use of ACE inhibitors and ARBs in patients with chronic kidney disease because these agents are renoprotective. However, slowing progression of kidney disease may not be the most patient-centric goal of therapy in many older adults with this condition.
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