What data are available to support the use of ACE-Is or ARBs in CKD patients?
Several analyses have shown a benefit of ACE-Is or ARBs over placebo or another agent, and although most of these studies were performed in patients with urine albumin levels below the macroalbuminuria cutoff, there is no obvious reason why the benefit would not extend to individuals with macroalbuminuria (Supplementary Tables 7 12 online). In summary, the data in support of the use of ACE-Is or ARBs are reasonably strong for preventing progression of CKD and less so for CVD protection. Notably, they show no harm of either class of drugs with regard to CVD. Taken together, the data on both drug classes support a grade 1B recommendation for ACE-Is or ARBs as a preferred agent in CKD patients with albumin excretion 4300 mg per 24 hours or its equivalent.