"Benazepril in Patients with Advanced Chronic Renal Insufficiency" The New England Journal of Medicine. PubMed•Full
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Does benazepril provide renal protection in patients without diabetes who have advanced renal insufficiency?
Benazepril, an angiotensin-converting enzyme (ACE) inhibitor, confers substantial renal benefits in patients without diabetes who have advanced renal insufficiency, without being merely attributable to blood pressure control.
ACE inhibitors are known to slow the progression of chronic kidney disease, particularly in patients with mild-to-moderate renal insufficiency. However, their effectiveness in advanced renal insufficiency has been less clear due to concerns about increased serum creatinine or potassium levels. This study indicated that benazepril, when added to conventional antihypertensive therapy, significantly improved renal outcomes in patients with stage 4 chronic kidney disease.
This study suggests that treatment with the ACE inhibitor benazepril may be beneficial for patients with stage 4 chronic kidney disease, potentially influencing therapeutic guidelines for this population.
Randomized, double-blind study with an 8-week run-in period, during which benazepril was administered before randomization. Afterward, Group 1 received 20 mg of benazepril per day, while Group 2 was randomized to benazepril or placebo.
422 Chinese patients aged 18 to 70 with chronic kidney disease and serum creatinine levels of 1.5 to 5.0 mg per deciliter.
Group 1 received open-label benazepril (20 mg per day) and Group 2 received either 20 mg of benazepril per day or placebo, along with other antihypertensive treatments.
Primary: Composite of a doubling of the serum creatinine level, end-stage renal disease, or death. Secondary: Changes in proteinuria level and rate of progression of renal disease.
- The effectiveness and safety of benazepril could vary with ethnicity, as Chinese patients may react differently to ACE inhibitors (e.g., higher incidence of dry cough). - The generalizability of the study findings' to other ethnic groups and to patients with concomitant diabetes mellitus may be limited. - Hyperkalemia was a concern, though managed effectively in the study.
National Nature and Sciences Grant for Major Projects and a People's Liberation Army Grant for Major Clinical Research, with partial support from Novartis.
ClinicalTrials.gov number, NCT00270426.