Progression of renal disease--can it be reversed? The role of calcium channel blockers and angiotensin-converting enzyme inhibitors.

The treatment of patients with end-stage renal failure using dialysis has become an important factor in the health budgets of the developed countries. Thus, prevention of progression of renal disease and a reduction in the number of patients requiring dialysis should have a beneficial impact on health budgets. This review will examine the effects of calcium channel blockers (CCBs) and angiotensin-converting enzyme inhibitors (ACE-Is) on the progression of renal disease. Both CCBs and ACE-Is have been shown to slow progression in various animal models of various renal diseases. In the human with diabetic and non-diabetic renal disease, most CCBs have caused a stabilization of renal function and in some cases a decrease in proteinuria. ACE-Is have been effective in reducing proteinuria and stabilizing renal function in both diabetic and non-diabetic disease, this effect being independent of the antihypertensive effect. There are good theoretical reasons for using a combination of these two classes of medications, but there are still insufficient clinical data. In summary, both CCBs and ACE-Is may be used to slow the progression of renal disease. ACE-Is seem to be preferable, but there may be an advantage to the use of a combination of both agents.