RAAS Inhibitors Prove Superior in Pediatric CKD Treatment

A large real-world study indicates renin-angiotensin-aldosterone system inhibitors (RAASi) are more effective than calcium channel blockers (CCB) as first-line treatment for hypertension in children with chronic kidney disease (CKD).

Researchers analyzed data from 2,762 pediatric patients aged 2-20 across 13 institutions. All had stage 2-4 CKD and began antihypertensive therapy between 2009 and 2020. Using a target trial emulation method, they compared outcomes between those starting on RAASi versus CCB.

Over two years, RAASi users had a 42% lower risk of progressing to kidney replacement therapy (aHR 0.58). They also showed significantly less decline in kidney function and spent less time with elevated systolic blood pressure-29% vs 39% above the 90th percentile.

The findings reinforce current clinical guidelines favoring RAASi as initial therapy. The study provides robust evidence in the absence of randomized trials, highlighting RAASi’s role in slowing CKD progression and improving cardiovascular metrics in children.