Ramipril can essentially abolish the excess risk for end-stage renal disease (ESRD) seen in obese persons with chronic kidney disease (CKD), according to a post hoc analysis of the Ramipril Efficacy in Nephropathy (REIN) trial.

In addition, the risk reduction conferred by the ACE inhibitor is greater among obese than non-obese patients, Carmine Zoccali, MD, and co-investigators concluded in a report published online ahead of print in the Journal of the American Society of Nephrology.

In 337 patients with non-diabetes-related CKD, the risk of developing ESRD was more than twice as high for obese patients compared with overweight or normal-weight patients: 24 vs. 11 or 10, respectively, per 100 person-years. Ramipril lowered the risk of progression to ESRD in all three groups, but much more so among the obese patients, who had an 86% risk reduction compared with 45% seen in the normal-weight group—lowering ESRD risk for obese patients to approximately the same level as that of normal-weight patients.

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