title: No clear evidence of ACEi efficacy on the progression of chronic kidney disease in children with hypodysplastic nephropathy--report from the ItalKid Project database.
abstract: BACKGROUND
  Chronic kidney diseases (CKD) tend to progress to end-stage renal failure (ESRF). As it has been demonstrated that angiotensin-converting enzyme inhibitors (ACEi) have a renoprotective effect in adults with proteinuric disease and may be effective in reducing hyperfiltration and proteinuria, they are also frequently used as anti-progression agents in paediatric patients with CKD despite the lack of data confirming their role in the nephropathies peculiar to children. The aim of this study was to investigate whether patients with hypodysplastic CKD (the most common cause of ESRF in children) treated with ACEi show a significantly slower decline in creatinine clearance (Ccr).
  
  
  METHODS
  The analysis was based on the information available in the database of the ItalKid Project, a nationwide, population-based registry of chronic renal insufficiency (CRI) in children in Italy. Of the 822 patients with CRI due to hypodysplasia, we selected those who had been continuously treated with ACEi; the control patients were identified from the same diagnostic group and matched for gender, age and baseline Ccr.
  
  
  RESULTS
  Progression was analysed as the slope of Ccr in a total of 164 patients: 41 cases and 123 matched controls. There were no significant between-group differences in blood pressure, duration of follow-up or pre-study slope of Ccr (-0.31+/-2.26 vs -0.33+/-3.58 ml/min/1.73 m2/year; P=NS). After an average of 4.9+/-2.3 years, the mean slope of Ccr was 40% lower in the ACEi-treated cases in comparison to controls (-1.08+/-2.08 vs -1.80+/-4.42 ml/min/1.73 m2/year), however, this difference was not statistically significant (P=0.31).
  
  
  CONCLUSIONS
  We conclude that ACEi treatment does not significantly modify the naturally progressive course of hypodysplastic nephropathy in children and further studies are necessary before such treatment is routinely proposed for anti-progression purposes in children with CKD.
authors.affiliation: Unit of Pediatric Nephrology, Dialysis and Transplantation, Department of Pediatrics, Via Commenda 9,I-20122 Milano, Italy. italkid@italkid.org
authors.forename: Gianluigi
authors.initials: G
authors.lastname: Ardissino
authors.forename: Sara
authors.initials: S
authors.lastname: Viganò
authors.forename: Sara
authors.initials: S
authors.lastname: Testa
authors.forename: Valeria
authors.initials: V
authors.lastname: Daccò
authors.forename: Fabio
authors.initials: F
authors.lastname: Paglialonga
authors.forename: Antonio
authors.initials: A
authors.lastname: Leoni
authors.forename: Mirco
authors.initials: M
authors.lastname: Belingheri
authors.forename: Luigi
authors.initials: L
authors.lastname: Avolio
authors.forename: Antonio
authors.initials: A
authors.lastname: Ciofani
authors.forename: Aldo
authors.initials: A
authors.lastname: Claris-Appiani
authors.forename: Daniele
authors.initials: D
authors.lastname: Cusi
authors.forename: Alberto
authors.initials: A
authors.lastname: Edefonti
authors.forename: Anita
authors.initials: A
authors.lastname: Ammenti
authors.forename: Milva
authors.initials: M
authors.lastname: Cecconi
authors.forename: Carmelo
authors.initials: C
authors.lastname: Fede
authors.forename: Luciana
authors.initials: L
authors.lastname: Ghio
authors.forename: Angela
authors.initials: A
authors.lastname: La Manna
authors.forename: Silvio
authors.initials: S
authors.lastname: Maringhini
authors.forename: Teresa
authors.initials: T
authors.lastname: Papalia
authors.forename: Ivana
authors.initials: I
authors.lastname: Pela
authors.forename: Lorena
authors.initials: L
authors.lastname: Pisanello
authors.forename: Ilse Maria
authors.initials: IM
authors.lastname: Ratsch
mesh_terms: D000293:Adolescent; D000328:Adult; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000494:pharmacology / Q000627:therapeutic use*; D001794:Blood Pressure / Q000187:drug effects; D016022:Case-Control Studies; D002648:Child; D003404:Creatinine / Q000378:metabolism; D016208:Databases, Factual; D003971:Diastole / Q000187:drug effects; D018450:Disease Progression; D005260:Female; D006801:Humans; D007558:Italy; D007676:Kidney Failure, Chronic / Q000150:complications* / Q000188:drug therapy* / Q000503:physiopathology; D007677:Kidney Function Tests; D008297:Male; D009393:Nephritis / Q000150:complications*; D013599:Systole / Q000187:drug effects; D016896:Treatment Outcome
chemical_list: D000806:Angiotensin-Converting Enzyme Inhibitors; D003404:Creatinine