Meta-analysis: Effect of ACE-Inhibitors on Outcomes in Patients with Renal Insufficiency

To assess the relationship between baseline serum creatinine (Scr) levels and the protective effect of angiotensin-converting enzyme (ACE)–inhibitors on the development of end-stage renal failure in patients with renal disease, we conducted a meta-analysis of all randomized controlled trials that compared ACE-inhibitors with either placebo or other antihypertensive agents in patients with renal insufficiency. The pooled outcome was end-stage renal failure or a doubling of the baseline serum creatinine concentration (DScr). ACE-inhibitors are effective in slowing the progression of renal insufficiency, not only in patients with a serum creatinine value of below 3.0 mg/dl but also in those with a serum creatinine value of 3.0 mg/dl or more.