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NDT Advance Access originally published online on July 5, 2006
Nephrology Dialysis Transplantation 2006 21(9):2348-2351; doi:10.1093/ndt/gfl315
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© The Author [2006]. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org

Editorial Comment

Progression of renal disease—can we forget about inhibition of the renin–angiotensin system?

Johannes F. E. Mann1, William M. McClellan2, Regina Kunz3 and Eberhardt Ritz4

1 Department of Nephrology, Schwabing General Hospital, Ludwig Maximilian University, Germany, 2 Department of Medicine, Emory University School of Medicine, USA, 3 Institute of Clinical Epidemiology, University of Basle, Switzerland and 4 Department of Nephrology, Ruperto Carola University, Heidelberg, Germany

Correspondence and offprint requests to: Johannes F. E. Mann, MD, Schwabing General Hospital, Ludwig Maximilians University, Kolner Platz 1, Munchen 80804, Germany. Email: johannes.mann@kms.mhn.de

Keywords: ACE; antihypertensive drugs; blood pressure; progression; renal insufficiency; renin

The first 150 words of the full text of this article appear below.



   Introduction
 
A recent meta-analysis by Casas et al. [1] concluded that ACE inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) reduce the progression of renal events by nothing more than their blood pressure (BP)-lowering effect. Surprisingly, this meta-analysis [1] contradicts most randomized controlled trials and other meta-analyses [2–5] investigating the effect of inhibition of the renin–angiotensin system (RAS) on the progression of chronic kidney disease. We have analysed the methodological quality of this meta-analysis and put it into perspective with other meta-analyses and large randomized controlled trials. We have come to the conclusion that there are serious problems, which undermine the conclusion drawn by Casas et al. [1].



   Data analysis by Casas et al. [1]
 
How did the authors reach their surprising conclusion? Casas et al. [1] selected randomized controlled trials comparing inhibitors of the RAS with other regimens, defining the progression of renal disease as . . . [Full Text of this Article]



   Blood pressure-independent nephroprotective effects of ACEI/ARB
 


   The ALLHAT trap
 


   ACEI/ARB not indicated in diabetic nephropathy?
 


   Comparison of Casas et al. with previous meta-analyses
 


   No data—Proteinuria, the hallmark of renal risk
 


   Lack of patient-level data
 


   Conclusions
 

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