Evidence for kidney protection from Lisinopril

[Dillinger]

Hi,

I take the ACE inhibitor Lisinopril not because I have high blood pressure (which I don't) but because of the purported protective effects it has on my kidneys.

However my GP doesn't know about that kidney protecting reasoning and just assumed I had high blood pressure; so does anyone know and have links to the studies that lead to that idea?

I know many of us are on this drug (for ever) but as the advice on statins seems to be so way off the mark I wonder how good the evidence is for this other big seller?

Thanks

Dillinger

 

[phoenix]

Cochrane
This systematic review aimed to assess the benefits and harms of blood pressure lowering agents in people with diabetes mellitus and a normal amount of albumin in the urine (normoalbuminuria) Fairly detailed summary but full text behind paywall.
http://onlinelibrary.wiley.com/doi/...ionid=5C612ADBAAA17ED4139ECF20E10C69EB.f03t04

If you have microalbuminuria then there is strong evidence that it delays progression to macroalbuminuria
'In some studies, the beneficial effect of ACE inhibitors or ARBs appeared greater than the difference in mean follow-up blood pressure or persisted after adjustment for follow-up blood pressure in multiple regression analysis, suggesting that the benefit is due to mechanisms in addition to the antihypertensive effect.'
https://www.kidney.org/professionals/kdoqi/guidelines_bp/guide_8.htm

 

[noblehead]

Much like yourself Dillinger I didn't have high bp before taking Ramipril but with having diabetic retinopathy at the time it was suggested I started on them, the reason being that the lower the bp the less strain there is on the eyes which has been proven to help with retinopathy.

I'm sure I've read that all bp drugs ending in 'pril' have beneficial effects for the kidneys, it makes sense to take one even at a low-dose if you think that you might be at a heightened risk or already have complications, really surprised your gp didn't know about the beneficial effects it has on protecting the kidney.

 

[Dillinger]

Thank you @phoenix - I could have guessed that you would have had that one up your sleeve!

This is the bit I'm particularly interested in; ACE inhibitors vs placebo in relation to onset of DKD (8 studies, 11,906 patients: RR 0.71, 95% CI 0.56 to 0.89), with similar benefits in people with and without hypertension (P = 0.74).

For the RR is that based on 1 being the same as the placebo so the reduction is about 30%?

Best

Dillinger

 

[squeezelouise400]

I have CKD stage 3 but my Kidneys are fine funnily enough I was told that I have managed to save my kidneys with improved blood glucose control after going on the pump as well as being on Lisinopril for many years. The Kidney specialist I saw explained that the Lisinopril has helped to save both my kidneys and my heart as well.

 

[Flowerpot]

I have had CKD stage 3 for about the last 12 years. My eGfr result was decreasing down towards Stage 2 with each blood test and I had microalbuminuria. I have low blood pressure but was prescribed Lisinopril about 10 years ago specifically to protect my kidneys. Since then I have stayed as I was in Stage 3 CKD and the microalbuminuria has not progressed but the knock on is my blood pressure remains low. My consultant maintains that taking Lisinopril has protected my kidney function from further decline and at present I am happy to believe that.