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Combination of enalapril and folic acid significantly delays CKD progression

In patients with mild-to-moderate chronic kidney disease, enalapril and folic acid therapy substantially reduced the risk for disease progression compared with enalapril alone, according to recent research.

“Chronic kidney disease (CKD) is a worldwide public health problem leading to poor outcomes and high cost; CKD substantially increases the risk of progression to end-stage renal disease and cardiovascular disease,” Xin Xu, MD, PhD, of the National Clinical Research Center for Kidney Disease at Nanfang Hospital in Guangzhou, China, and colleagues wrote. “New therapeutic interventions that slow down the decline in renal function in patients with CKD are critically needed.”

Xu and colleagues performed a renal substudy analysis of the China Stroke Primary Prevention Trial compared the effectiveness of enalapril and folic acid to enalapril alone at delaying CKD progression in Chinese adults with hypertension.

The cohort included 15,104 participants (mean age, 60 years) with an estimated glomerular filtration rate (eGFR) of 30 mL/min/1.73 m² or higher. Of those, 1,671 patients had CKD. Participants were randomly assigned to a once-daily dose of either a combination of 10 mg of enalapril and 0.8 mg of folic acid (n = 7,545) or 10 mg of enalapril alone (n = 7,559).

The median follow-up was 4.4 years. The primary outcome event was progression of CKD or end-stage renal disease. There were 164 primary events in the enalapril group and 132 primary events in the enalapril-folic acid group.

Results showed that enalapril-folic acid decreased the risk for CKD progression by 21% (OR = 0.79; 95% CI, 0.62-1). In addition, enalapril-folic acid significantly slowed the rate of eGFR decline (1.28% vs. 1.42% per year; P = .02).

Overall, patients with CKD treated with folic acid therapy had a significantly lower risk for a primary event (OR = 0.44; 95% CI, 0.26-0.75) and a lower risk for rapid decline in renal function (OR = 0.67; 95% CI, 0.47-0.96) and the composite event (OR = 0.62; 95% CI, 0.43-0.9), as well as a 44% slower rate of renal function decline (0.96% vs. 1.72% per year, P < .001). There were no differences between the treatment groups among participants without CKD.

“Given the magnitude of renal protection suggested by this study as well as the safety and the low cost, the potential role of folic acid therapy in the clinical management of patients with CKD in regions without folic acid fortification should be vigorously examined,” Xu and colleagues concluded. – by Alaina Tedesco

Disclosures: Xu reports grants from the Major Scientific and Technological Planning Project of Guangzhou, the Science, Technology and Innovation Committee of Shenzhen, and personal fees from AUSA Research Institute, Shenzhen AUSA. Please see the full study for a complete list of all other authors' relevant financial disclosures.