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Dtsch Med Wochenschr 2018; 143(12): 880-885
DOI: 10.1055/a-0549-9662
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© Georg Thieme Verlag KG Stuttgart · New York

ACE-I und ARB bei chronischen Nierenerkrankungen: Was muss ich berücksichtigen?

ACE Inhibitors and ARB in Chronic Kidney Disease: What Has to Be Considered
Martin Zeier
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Publication History

Publication Date:
13 June 2018 (online)

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Abstract

Proteinuric kidney disease, especially in the early and middle stages of renal insufficiency, may be favorably affected by ACE-I/ARB. The progression of renal insufficiency is thereby slowed down and dialysis obligation occurs later or can even be avoided. This effect is independent of the underlying glomerular kidney disease. In the advanced stage of renal insufficiency, the benefit of ACE-I/ARB cannot yet be conclusively assessed. The interruption of ACE-I/ARB therapy may possibly contribute to a certain recovery of renal function and delay the onset of dialysis a little. However, studies are still pending and the benefits of ACE-I/ARB for the heart and blood vessels, especially at this stage of renal insufficiency, should not be overlooked.

Patients with proteinuria benefit from ACE-I/ARB not only in terms of renal stabilization. A cardio-protective effect by reduction of proteinuria and a delay of progression is proven. On the other hand, the protective effect of ACE-I/ARB that can be detected directly on the heart and blood vessels should not be disregarded. Thus, even if chronic renal insufficiency no longer benefits directly from ACE-I/ARB therapy, cardiac protection may still be of great importance to the chronic kidney patient.

Angiotensin-Converting-Enzyme-Inhibitoren (ACE-I) und Angiotensin-II-Rezeptor-Blocker (ARB) werden häufig bei einer frühen Niereninsuffizienz eingesetzt. Sie verlangsamen die Progression der Erkrankung und haben eine kardioprotektive Wirkung. Wie diese Therapieform aber bei einer fortgeschrittenen Niereninsuffizienz (eGFR < 30 ml/min) zu bewerten ist, darüber besteht eine nicht unerhebliche Unsicherheit.

Schlüsselwörter

ACE-Inhibitor - ARB - Filtrationsrate - kardioprotektiv - Diabetes

Key words

ACE inhibitor - ARB - filtration rate - cardioprotective - diabetes
 

  • Literatur

  • 1 Anderson S, Brenner BM. The role of intraglomerular pressure in the initiation and progression of renal disease. J Hypertension 1986; 4: S236-S238
    PubMedGoogle Scholar
  • 2 Levin A, Tonelli M, Bonventre J. et al. Global kidney health 2017 and beyond: a roadmap for closing gaps in care, research and policy. Lancet 2017; 390: 1888-1917
    CrossrefPubMedGoogle Scholar
  • 3 Hill NR, Fatoba ST, Oke JL. et al. Global Prevalence of chronic kidney diseaes – a systematic review and meta-analysis. Plos One 2016; 11 DOI: e0158765.
    CrossrefPubMedGoogle Scholar
  • 4 Levin A, Stevens PE, Bilous RW. et al. Kidney Disease: Improvement of Global Outcomes (KDIGO) CKD Workgroup. KIDIGO 2012 clinical practice guidelines for the evaluation and management of chronic kidney disease. Kidney Int Suppl 2013; 3: 1-150
    CrossrefPubMedGoogle Scholar
  • 5 Zoccali C, Vanholder R, Massy ZA. et al. The systemic nature of CKD. Nature Reviews Nephrology 2017; 13: 344-358
    CrossrefPubMedGoogle Scholar
  • 6 Levey AS, Coresh J. Chronic kidney disease. Lancet 2012; 379: 165-180
    CrossrefPubMedGoogle Scholar
  • 7 Romagnani P, Remuzzi G, Glassok R. et al. Chronic kidney disease. Nature Reviews Disease Primers 2017; DOI: 10.1038/nrdp.2017.88.
    CrossrefPubMedGoogle Scholar
  • 8 Lewis EJ, Hunsicker LG, Clarke WR. et al. Collaborative Study Group: Renoprotective effect of the angiotensin-receptor antagonist irbesartan in patients with nephropathy due to type 2 diabetes. N Engl J Med 2001; 345: 851-860
    CrossrefPubMedGoogle Scholar
  • 9 Brenner BM, Cooper ME, de Zeeuw D. et al. RENAAL Study Investigators: Effects of losartan on renal and cardiovascular outcomes in patients with type 2 diabetes and nephropathy. N Engl J Med 2001; 345: 861-869
    CrossrefPubMedGoogle Scholar
  • 10 De Zeeuw D, Remuzzi G, Parving HH. et al. Proteinuria, a target for renoprotection in patients with type 2 diabetic nephropathy: lessons from RENAAL. Kidney Int 2004; 65: 2309-2320
    CrossrefPubMedGoogle Scholar
  • 11 Lewis EJ, Hunsicker LG, Bain RP. et al. The effect of angiotensin-converting-enzyme inhibition on diabetic nephropathy. The collaborative study group. N Engl J Med 1993; 329: 1456-1462
    CrossrefPubMedGoogle Scholar
  • 12 ALLHAT Officers and Coordinators for the ALLHAT Collaborative Research Group. Major Outcomes in high-risk hypertensive patients randomized to angiotensin-converting enzyme inhibitor or calcium channel blocker vs. diuretic: the antihypertensive and lipid-lowering treatment to prevent heart attack trial (ALLHAT). JAMA 2002; 288: 2981-2997
    CrossrefPubMedGoogle Scholar
  • 13 Ruggenenti P, Fassi A, Ilieva AP. et al. Bergamo Nephrologic Diabetes Complications Trial (BENEDICT) Investigators: Preventing microalbuminuria in type 2 diabetes. N Engl J Med 2004; 351: 1941-1951
    CrossrefPubMedGoogle Scholar
  • 14 Jamerson K, Weber MA, Bakris GL. et al. ACCOMPLISH Trial Investigators: Benazepril plus Amlodipine or Hydrochlorothiazide for hypertension in high-risk patients. N Engl J Med 2008; 359: 2417-2428
    CrossrefPubMedGoogle Scholar
  • 15 Haller H, Ito S, Izzo JL. et al. ROADMAP Trial Investigators: Olmesartan for the delay or prevention of microalbuminuria in type 2 diabetes. N Engl J Med 2011; 364: 907-917
    CrossrefPubMedGoogle Scholar
  • 16 Hou FF, Xie D, Zhang X. et al. Renoprotection of optimal antiproteinuric doses (ROAD) study: a randomized controlled study for Benazepril and losartan in chronic renal insufficiency. J Am Soc Nephrol 2007; 18: 1889-1898
    CrossrefPubMedGoogle Scholar
  • 17 Appel LJ, Wirght JT, Greene T. et al. Intensive blood-pressure control in hypertensive chronic kidney disease. N Engl J Med 2010; 363: 918-929
    CrossrefPubMedGoogle Scholar
  • 18 Ruggenenti P, Perna A, Gherardi G. et al. Renal function and requirement for dialysis in chronic nephropathy patients on long-term ramipril: REIN follow-up trial. Gruppo Italiano di Studi Epidemiologici in Nefrologia (GISEN).. Ramipril Efficiacy in Nephropathy. Lancet 1998; 352: 1252-1256
    PubMedGoogle Scholar
  • 19 Maschio G, Alberti D, Janin G. et al. Effect of the angiotensin-converting-enzyme inhibitor benazepril on the progression of chronic renal insufficiency. The angiotensin-converting-enzyme inhibition in progressive renal insufficiency study group. N Engl J Med 1996; 334: 939-945
    CrossrefPubMedGoogle Scholar
  • 20 Matsushita K, van der Velde M, Astor BC. et al. Chronic Kidney Disease Prognosis Consortium. Association of estimated glomerular filtration rate and albuminuria with all-cause and cardiovascular mortality in general population cohorts: a collaborative meta-analysis. Lancet 2010; 375: 2073-2081
    CrossrefPubMedGoogle Scholar
  • 21 Aimun A, Jorna T, Bhandari S. Should we stop Angiotensin Converting Enzyme Inhibitors/Angiotensin Receptor Blockers in advanced kidney disease?. Nephron Clin Practice 2016; 133: 147-158 . doi:19.1159/000447068
    PubMedGoogle Scholar
  • 22 Molnar MZ, Kalantar-Zadeh K, Lott EH. et al. Angiotensin-converting enzyme inhibitor, angiotensin receptor blocker use, and mortality in patients with chronic kidney disease. J Am Coll Cardiol 2014; 63: 650-658
    CrossrefPubMedGoogle Scholar
  • 23 Ahmed AK, Kamath NS, Kossi M. et al. The impact of stopping inhibitors of the renin-angiotensin-system in patients with advanced chronic kidney disease. Nephrol Dial Transplant 2010; 25: 3977-3982
    CrossrefPubMedGoogle Scholar
  • 24 Bhandari S, Ives N, Brettell EA. et al. Multicentre randomized controlled trial of angiotensin-converting enzyme inhibitor/angiotensin receptor blocker withdrawal in advanced renal disease; the STOP-ACEi trial. Nephrol Dial Transplant 2016; 31: 255-261
    PubMedGoogle Scholar
  • 25 Strippoli GF, Bonifati C, Craig M. et al. Angiotensin converting enzyme inhibitors and angtiotensin II receptor antagonists for preventing the progression of diabetic kidney disease. Cochrane Database Syst Rev 2006; 4 DOI: CD 006257.
    CrossrefPubMedGoogle Scholar
  • 26 Ruggenenti P, Perna A, Remuzzi G. Gruppo Italiano di Studi Epidemilogici in Nefrologia: ACE-inhibitors to prevent end-stage renal disease: when to start and why possibly never to stop: a post hoc analysis of the REIN trial results. J Am Soc Nephrol 2001; 12: 2832-2837
    PubMedGoogle Scholar
  • 27 Ruggenenti P, Perna A, Loriga G. et al. Blood pressure control for renoprotection in patients with non-diabetic chronic renal disease (REIN-2): multicentre, randomised controlled trial. Lancet 2005; 365: 939-946
    CrossrefPubMedGoogle Scholar
  • 28 Kunz R, Friedrich D, Wolbers M. et al. Meta-analysis: effect of monotherapy and combination therapy with inhibitors of the renin-angiotensin-system on proteinuria in renal disease. Ann Int Med 2008; 148: 30-48
    CrossrefPubMedGoogle Scholar
  • 29 Parving HH, Brenner BM, McMurray JJ. et al. Cardiorenal end points in a trial of aliskiren for type 2 diabetes. N Engl J Med 2012; 367: 2204-2213
    CrossrefPubMedGoogle Scholar
  • 30 Mann JF, Schmieder RE, McQueen M. et al. ONTARGET Investigators: Renal outcomes with temisartan, ramipril, or both, in people with high vascular risk (the ONTARGET study): a mulitcentre, randomized, double-blind, controlled trial. Lancet 2008; 372: 547-553
    CrossrefPubMedGoogle Scholar