Summary
Angiotensin Ii has reached the approved stage (maximum clinical phase 4) for at least one indication, so its use in Chronic Kidney Disease would be drug repurposing rather than first-in-human development. This does not mean it is approved for Chronic Kidney Disease. ClinicalTrials.gov lists 8 registered trials linking Angiotensin Ii to Chronic Kidney Disease: 6 have completed; 2 are terminated, withdrawn, suspended or of unknown status. The most advanced is Phase 4 (NCT00858299). It plans or enrolled 500 participants. Registration activity spans 2003 to 2024. The literature layer holds 12 publications for this pair: 5 Cochrane reviews, 1 meta-analysis, 1 systematic review and 5 clinical trial publications. Publication years run from 2018 to 2026. Because at least one synthesis-level source exists (systematic review, meta-analysis or Cochrane review), this pair has been assessed beyond single studies, although the synthesis may concern a different indication.
The RepurpOS disease-intelligence file for Chronic Kidney Disease ranks 534 candidate therapeutics from Open Targets, ChEMBL, DGIdb and PubMed; only a minority carry direct clinical evidence, and this page covers one of those. Spontaneous remission context recorded for the condition: GFR decline averages 2-5 mL/min/year on standard care (ACE/ARB + blood pressure control); progression to end-stage renal disease (ESRD) in ~20-30% at 10 years for moderate CKD; reversal essentially impossible once structural fibrosis established.
Evidence table
| Evidence tier | A · Strong |
|---|---|
| Evidence score | 77.0 (trials 27.0, literature 30.0, tier 15, approved bonus 5.0) |
| Registered trials | 8 total: 0 recruiting, 0 active / not yet recruiting, 6 completed, 2 other |
| Linked publications | 12 (5 Cochrane reviews, 5 clinical trial publications, 1 meta-analysis, 1 systematic review) |
| Agent type | Drug (Small molecule) |
| Development stage (any indication) | Approved |
| Mechanism / class | agonist |
| Data sources | DGIdb |
| Linked via biomarker / target | AGTR1 |
How the evidence score is calculated
- Each registered trial scores by status (recruiting / active / enrolling 3, completed 2.5, not yet recruiting 2, unknown 1, terminated / withdrawn / suspended 0.5) plus a phase bonus (phase 3-4 +2, phase 2 +1, phase 1 +0.5). The trial component is capped at 30.
- Each literature item scores by design (Cochrane review 5, meta-analysis 4, systematic review 3, RCT 3, clinical trial publication 2, curated reference 1.5, other PubMed record 1). The literature component is capped at 30.
- The existing evidence tier adds 15 (A / Strong), 10 (B / Moderate), 5 (C / Preliminary) or 0 (D / Anecdotal).
- Agents approved for any indication (max clinical phase 4) add 5, because an approved agent has an established safety profile that lowers the barrier to repurposing trials.
- The score ranks what has been studied, not what works. It does not read effect sizes or directions of effect.
Registered clinical trials
| NCT ID | Title | Status | Phase | Enrolment |
|---|---|---|---|---|
| NCT00190580 | Kanagawa Valsartan Trial (KVT): Effects of Valsartan on Renal and Cardiovascular Disease 2003 | completed | Phase 4 | 312 |
| NCT00858299 | The Change of Urinary Angiotensinogen Excretion After Valsartan Treatment in Patients With Persistent Proteinuria 2009 | status unknown | Phase 4 | 500 |
| NCT01377285 | Renoprotection by Pentoxifylline and Angiotensin Receptor Blocker in Chronic Kidney Disease (CKD) 2010 | status unknown | Phase 4 | 350 |
| NCT00791830 | Saving Residual Renal Function Among Haemodialysis Patients Receiving Irbesartan 2009 | completed | Phase 3 | 82 |
| NCT06272487 | Zilebesiran as Add-on Therapy in Patients With High Cardiovascular Risk and Hypertension Not Adequately Controlled by Standard of Care Antihypertensive Medications (KARDIA-3) 2024 | completed | Phase 2 | 375 |
| NCT01371747 | Patiromer in the Treatment of Hyperkalemia in Patients With Hypertension and Diabetic Nephropathy (AMETHYST-DN) 2011 | completed | Phase 2 | 324 |
| NCT00572312 | Optimalization of Nephroprotection Using Atorvastatin (Sortis) 2005 | completed | Not applicable | — |
| NCT00395005 | Correlation of Urinary Kallikrein With Cytokines, Proteinuria and Renal Function in Chronic Renal Disease Patients 2006 | completed | Not applicable | 50 |
Published literature
- Clinical trial publication Pharmacogenomics-Guided Precision Therapy for Chronic Kidney Disease with Resistant Hypertension: A Prospective Cohort StudyHa X, Gao X, Teng W et al. · Kidney & blood pressure research · 2026 · PMID 41363682
- Cochrane review All in on ARBs: Is it time to fold the ACEIs?Phan P, Pham B, Yang M et al. · Canadian family physician Medecin de famille canadien · 2026 · PMID 41844292
- Clinical trial publication User Actions within a Clinical Decision Support Alert for the Management of Hypertension in Chronic Kidney DiseaseSamal L, Chen SW, Lipsitz S et al. · Applied clinical informatics · 2025 · PMID 40097147
- Clinical trial publication A Pilot, Single-Blinded, Randomized Crossover Trial of Cramp Reduction with Angiotensin II in Maintenance Patients on Hemodialysis (the CRAMP-HD Study)Phongphithakchai A, Bellomo R, Mount P et al. · American journal of nephrology · 2025 · PMID 39809227
- Clinical trial publication A Five-Year Prospective, Randomized, Open-Label Study of Standard-Dose Versus Low-Dose Prolonged-Release Tacrolimus With or Without Angiotensin-Converting Enzyme Inhibitor or Angiotensin II Receptor Blocker Post Kidney TransplantationCampbell PM, Cantarovich M, Gangji A et al. · Clinical transplantation · 2025 · PMID 39739990
- Cochrane review Novel Potassium Binders in Reduction of Hyperkalemia and Optimization of RAAS Inhibitors Treatment in Patients with Chronic Kidney Disease or Heart Failure: A Systematic Review and Meta-analysisHuang N, Xu Y, Liu C et al. · Drugs · 2025 · PMID 40542996
- Clinical trial publication Efficacy and safety of sparsentan versus irbesartan in patients with IgA nephropathy (PROTECT): 2-year results from a randomised, active-controlled, phase 3 trialRovin BH, Barratt J, Heerspink HJL et al. · Lancet (London, England) · 2023 · PMID 37931634
- Cochrane review Benefits of SGLT2 inhibitors combining with renin-angiotensin-system blockers on cardiovascular outcomes in chronic kidney disease patients: A systemic review and meta-analysisLiu T, Li R, Wang X et al. · Medicina clinica · 2022 · PMID 34872768
- Systematic review Transglutaminase 2 as a novel target in chronic kidney disease - Methods, mechanisms and pharmacological inhibitionPrat-Duran J, Pinilla E, Nørregaard R et al. · Pharmacology & therapeutics · 2021 · PMID 33307141
- Cochrane review ACE Inhibitor Benefit to Kidney and Cardiovascular Outcomes for Patients with Non-Dialysis Chronic Kidney Disease Stages 3-5: A Network Meta-Analysis of Randomised Clinical TrialsZhang Y, He D, Zhang W et al. · Drugs · 2020 · PMID 32333236
- Cochrane review Renin-angiotensin system inhibitors in hypertensive adults with non-diabetic CKD with or without proteinuria: a systematic review and meta-analysis of randomized trialsMishima E, Haruna Y, Arima H · Hypertension research : official journal of the Japanese Society of Hypertension · 2019 · PMID 30948820
- Meta-analysis Effects of Angiotensin-Converting Enzyme Inhibitors and Angiotensin II Receptor Blockers on All-Cause Mortality and Renal Outcomes in Patients with Diabetes and Albuminuria: a Systematic Review and Meta-AnalysisWang K, Hu J, Luo T et al. · Kidney & blood pressure research · 2018 · PMID 29794446
Mechanism and notes
Recorded mechanism or class: agonist.
OSMF's existing evidence tier for this pair is A (Strong), derived from the strength of the disease association recorded in DGIdb, in this case via the biomarker or target AGTR1. The tier describes how well the drug-disease link is documented, not how well the drug works.
Frequently asked questions
Is Angiotensin Ii approved for Chronic Kidney Disease?
Angiotensin Ii has reached the approved stage (maximum clinical phase 4) for at least one indication, so its use in Chronic Kidney Disease would be drug repurposing rather than first-in-human development. This does not mean it is approved for Chronic Kidney Disease. Approval status for the specific indication should always be confirmed with the relevant regulator and prescribing information.
Is Angiotensin Ii in clinical trials for Chronic Kidney Disease?
ClinicalTrials.gov lists 8 registered trials linking Angiotensin Ii to Chronic Kidney Disease: 6 have completed; 2 are terminated, withdrawn, suspended or of unknown status. The most advanced is Phase 4 (NCT00858299). It plans or enrolled 500 participants. Registration activity spans 2003 to 2024.
What does the evidence show for Angiotensin Ii in Chronic Kidney Disease?
Angiotensin Ii has both completed registered trials and synthesis-level publications linked to Chronic Kidney Disease. That is the strongest profile in this database, but the summaries here do not extract effect sizes, so read the linked reviews for direction and magnitude of benefit. OSMF's existing evidence tier for this pair is A (Strong), derived from the strength of the disease association recorded in DGIdb, in this case via the biomarker or target AGTR1. The tier describes how well the drug-disease link is documented, not how well the drug works.
Cite this page
Data: ClinicalTrials.gov, PubMed, Open Targets, ChEMBL, DGIdb and the OSMF therapeutic agent database. Last updated 2026-07-05. Page built 2026-10-07.