What have recent observational studies suggested regarding the use of ACE-I or ARB in elderly patients with advanced CKD?
Recent observational studies have suggested that use of ACE-I or ARB in elderly patients with advanced CKD may compromise residual kidney function or even accelerate its rate of decline in both diabetic and non-diabetic patients. However, an RCT that specifically randomized patients with advanced CKD to benzapril or placebo did not support this opinion, and instead reported that 112 predominantly CKD 4 patients with a mean GFR of 26 ml/min/1.73 m2 receiving benzapril had a lower risk of doubling of SCr, kidney failure, or death compared with the same number of patients receiving placebo.