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Invited Commentary
March 2014

An ACE in the Hole for Patients With Advanced Chronic Kidney Disease?

Author Affiliations
  • 1Division of Nephrology, University of California, San Francisco
JAMA Intern Med. 2014;174(3):355-356. doi:10.1001/jamainternmed.2013.12176

In the treatment of patients with advanced chronic kidney disease (CKD) (which can be considered present when the estimated glomerular filtration rate [GFR] falls to <20 mL/min/1.73m2 and individuals become eligible to accrue time on the kidney transplant waiting list in the United States), a paramount goal is preventing or retarding progression to end-stage renal disease and the requirement of dialysis. At earlier stages of CKD, blockade of the renin-angiotensin-aldosterone system (RAAS) is a mainstay therapy; angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin II receptor blockers (ARBs) clearly slow renal function decline, especially among those with proteinuria. However, the use of ACEIs or ARBs in advanced CKD remains uncertain. This important clinical question is the subject of a new study by Hsu and colleagues.1

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