Ardissino G et al. (2007) No clear evidence of ACEi efficacy on the progression of chronic kidney disease in children with hypodysplastic nephropathy—report from the ItalKid Project database. Nephrol Dial Transplant [doi:10.1093/ndt/gfm237]

Angiotensin-converting-enzyme (ACE) inhibitors have been shown to have a renoprotective effect in adults with chronic renal insufficiency (CRI). There is a lack of evidence for similar effects in pediatric patients; nevertheless, ACE inhibitors are commonly used as antiprogression agents in these individuals, despite the very different etiologies, clinical courses and outcomes of CRI in adults and children. Most notably, children with chronic kidney diseases often do not have hypertension or proteinuria.

After analyzing data from the Italian Pediatric Registry of Chronic Renal Failure (ItalKid Project), Ardissino and co-workers have reported no apparent benefits of ACE inhibitors for delaying progression of renal disease in children with hypodysplastic nephropathy, the most common cause of pediatric CRI. In comparison with 123 controls matched by age, gender, diagnosis and baseline creatinine clearance, the rate of progression of CRI (measured as the slope of creatinine clearance over time) was not significantly reduced in 41 children treated with ACE inhibitors. There was, however, a trend towards slower progression in the treatment group (slope −1.08 ± 2.08 vs −1.80 ± 4.42 ml/min/1.73 m2/year; P = 0.31). No significant differences in creatinine clearance slopes were observed when participants were grouped by initial severity of renal impairment, suggesting that selection bias did not influence the results of the analysis.

The authors conclude that use of ACE inhibitors as antiprogression agents should continue to be regarded as experimental in children with hypodysplastic chronic kidney diseases.