CLINICAL QUESTION

Do angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs) reduce progression to end-stage kidney disease in patients with diabetic kidney disease?

EVIDENCE-BASED ANSWER

Use of ACE inhibitor or ARB therapy reduces progression to end-stage kidney disease in patients with diabetic kidney disease.¹ (Strength of Recommendation: C, consensus, usual practice, disease-oriented evidence, case series for studies of treatment or screening, and/or opinion.) Neither ACE inhibitor nor ARB therapy has been associated with reduced all-cause or cardiovascular mortality compared with placebo in patients with diabetic nephropathy.

PRACTICE POINTERS

Family physicians routinely treat patients with diabetes and kidney disease. Diabetic kidney disease, or diabetic nephropathy, is defined by the presence of persistent albuminuria (less than 300 mg/day) on two separate occasions at least 3 months apart in patients with type 1 or 2 diabetes, with or without a reduced estimated glomerular filtration rate.^1,2 Diabetic nephropathy is the most common cause of end-stage kidney disease globally and is highly associated with poor cardiovascular outcomes.² End-stage kidney disease is defined as requiring kidney replacement therapy (eg, dialysis) or kidney transplantation.³ As a precursor to overt diabetic nephropathy, microalbuminuria (30–300 mg/day) is presented in this review as an important early indicator and clinical outcome pertinent to diabetic kidney disease.¹