Table 1.

Major randomized controlled trials evaluating the effect of RAAS-blockade on renal outcomes and the associated risk of hyperkalemia among patients with proteinuric CKD

Study	Patient characteristics	N	Intervention	Follow-up	Effect on renal outcomes		Associated hyperkalemia risk
					DScr	ESRD	Definition	Incidence in RAAS group	Incidence in control group	Comparison	Ref
Collaborate study group trial	Type 1 DM with overt nephropathy	409	Captopril (25 mg thrice daily) vs placebo	3 yrs	↓	↓	sK ≥6.0 mEq/L	1.4%	0%	non-significant	17
RENAAL	Type 2 DM with overt nephropathy	1,513	Losartan (50–100 mg/day) vs placebo	3.4 yrs	↓	↓	sK ≥5.5 mEq/L	24.2%	12.3%	HR:2.0; 95% CI: 1.56–2.57)	15
IDNT	Type 2 DM with overt nephropathy	1,715	Irbesartan (300 mg/d) vs Amlodipine (10 mg/d) vs placebo	2.6 yrs	↓	↓	sK ≥6.0 mEq/L	18.6%	6%	P<0.001 vs placebo	18
REIN-2	Non-diabetic, proteinuric CKD	352	Ramipril (5 mg/d) vs placebo	1.25 yrs	↓	↓	NR	NR	NR	NR	14
AASK	African-Americans with hypertensive nephrosclerosis	1,094	Ramipril (2.5–10 mg/d) vs metoprolol (50– 200 mg/d) vs amlodipine (5–10 mg/d)	3–6.1 yrs	↓	↓	≥5.5 sK mEq/L	2.45 events per 100 patients-months	1.33 events per 100 patient-months	ACEI vs CCB: HR= 7.0; 95% CI:2.29–21.39. ACEI vs BB: HR= 2.85; 95% CI: 1.50–5.42.	19
Benazepril for advanced renal insufficiency	Advanced-stage, non-diabetic, proteinuric CKD	224	Benazepril (20 mg/d) vs placebo	3.4 yrs	↓	↓	sK ≥6.0 mEq/L	5.4%	4.5%	non-significant	16

Abbreviations: DM= diabetes mellitus; CV= cardiovascular; CKD= chronic kidney disease; ACEI= angiotensin-converting-enzyme-inhibitor; ARB= angiotensin-receptor-blocker; DSCr= doubling of serum creatinine; ESRD= end-stage-renal-disease; RENAAL= Reduction of Endpoints in NIDDM with the Angiotensin II Antagonist Losartan; IDNT= Irbesartan Diabetic Nephropathy Trial; REIN-2= Ramipril-Efficacy-In-Nephropathy-2; AASK= African American Study of Kidney Disease

↓ indicates significant reduction versus control group