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Current Guidelines for Using Angiotensin-Converting Enzyme Inhibitors and Angiotensin II–Receptor Antagonists in Chronic Kidney Disease: Is the Evidence Base Relevant to Older Adults?

Ann M. O'Hare, MD; James S. Kaufman, MD; Kenneth E. Covinsky, MD, MPH; C. Seth Landefeld, MD; Lynne V. McFarland, PhD; and Eric B. Larson, MD, MPH
[+] Article and Author Information

From the University of Washington and Veterans Affairs Puget Sound Health Care System, and Group Health Center for Health Studies, Seattle, Washington; Veterans Affairs Boston Healthcare System and Boston University School of Medicine, Boston, Massachusetts; and University of California, San Francisco, and San Francisco Veterans Affairs Medical Center, San Francisco, California.


Disclaimer: The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs.

Acknowledgment: The authors thank Drs. Bill Hazzard and Rudy Rodriguez for their insightful comments on several drafts of this manuscript.

Note: In-progress versions of this work were presented at the National Kidney Foundation Spring Clinical Meetings, Dallas, Texas, 2–6 April 2008, and the American Society of Nephrology–Association of Specialty Professors Workshop on Prediction, Progression, and Outcomes of Chronic Kidney Disease in Older Adults, Arlington, Virginia, 9–10 May 2008.

Grant Support: By a Beeson Career Development Award from the National Institute on Aging to Dr. O'Hare (K 1K23AG28980).

Potential Financial Conflicts of Interest:Grants received: A.M. O'Hare (Centers for Disease Control and Prevention), J.S. Kaufman (Department of Veterans Affairs, National Institutes of Health, Keryx, Proteon, Genzyme), K.E. Covinsky (National Institute on Aging, San Francisco Veterans Affairs Medical Center, University of California, San Francisco), C.S. Landefeld (National Institute on Aging, San Francisco Veterans Affairs Medical Center, University of California, San Francisco), E.B. Larson (National Institute on Aging, National Human Genome Research Institute, National Center for Research Resources, National Heart, Lung, and Blood Institute). Royalties: A.M. O'Hare (UpToDate), E.B Larson (UpToDate).

Requests for Single Reprints: Ann M. O'Hare, MD, Division of Nephrology, Department of Medicine, University of Washington and Veterans Affairs Puget Sound Health Care System, Nephrology and Renal Dialysis Unit, Building 100, Room 5B113, 1660 South Columbian Way, Seattle, WA 98108; e-mail, ann.ohare@va.gov.

Current Author Addresses: Dr. O'Hare: Division of Nephrology, Department of Medicine, University of Washington and Veterans Affairs Puget Sound Health Care System, Nephrology and Renal Dialysis Unit, Building 100, Room 5B113, 1660 South Columbian Way, Seattle, WA 98108.

Dr. Kaufman: Veterans Affairs Boston Healthcare System and Boston University School of Medicine Renal Section (111-RE), 150 South Huntington Avenue, Boston, MA 02130.

Drs. Covinsky and Landefeld: University of California, San Francisco, San Francisco Veterans Affairs Medical Center, 4150 Clement Street (181G), San Francisco, CA 94121.

Dr. McFarland: Northwest Center for Outcomes Research in Older Adults, Veterans Affairs Puget Sound Health Care System (S-152), 1100 Olive Way, Suite 1400, Seattle, WA 98101.

Dr. Larson: Group Health Center for Health Studies, 1730 Minor Avenue, Suite 1600, Seattle, WA 98101-1448.

Author Contributions: Conception and design: A.M. O'Hare, E.B. Larson.

Analysis and interpretation of the data: A.M. O'Hare, J.S. Kaufman, K.E. Covinsky, L.V. McFarland, E.B. Larson.

Drafting of the article: A.M. O'Hare, E.B. Larson.

Critical revision of the article for important intellectual content: A.M. O'Hare, J.S. Kaufman, K.E. Covinsky, C.S. Landefeld, L.V. McFarland, E.B. Larson.

Final approval of the article: A.M. O'Hare, J.S. Kaufman, K.E. Covinsky, C.S. Landefeld, L.V. McFarland, E.B. Larson.

Provision of study materials or patients: A.M. O'Hare.

Statistical expertise: A.M. O'Hare, J.S. Kaufman, L.V. McFarland, E.B. Larson.

Obtaining of funding: A.M. O'Hare.

Administrative, technical, or logistic support: A.M. O'Hare, E.B. Larson.

Collection and assembly of data: A.M. O'Hare.


Ann Intern Med. 2009;150(10):717-724. doi:10.7326/0003-4819-150-10-200905190-00010
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Angiotensin-converting enzyme inhibitors and angiotensin II–receptor antagonists are recommended for patients with chronic kidney disease because these drugs can slow disease progression. Older adults account for a large and growing number of patients with chronic kidney disease. The authors evaluated the relevance to adults older than 70 years of the evidence base for major U.S. practice guidelines for the use of these agents in chronic kidney disease. The authors first examined the representation of older adults in randomized trials that underpin these guidelines, then compared the characteristics of participants in these trials with those of a representative sample of older adults with chronic kidney disease in the general population. The authors found that current guidelines for the use of angiotensin-converting enzyme inhibitors and angiotensin II–receptor antagonists in chronic kidney disease are based on evidence with limited relevance to most persons older than 70 years with this condition.

Figures

Grahic Jump Location
Figure.
Prevalence of chronic kidney disease, by age group.

ACR = albumin–creatinine ratio; eGFR = estimated glomerular filtration rate.

Grahic Jump Location

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