ACE and chronic kidney disease: Multiple studies and the American Diabetes Association Clinical Practice Recommendations for 2008 sustain inclusion of these drugs as first line medications in a reno-protective regimen.37 The natural history of diabetic nephropathy, in terms of duration of stages of chronic kidney disease (CKD) prior to onset of ESRD,38 has required continuous revision to reflect an improving prognosis, meaning extension of each phase of chronic kidney disease,39 in patients under treatment with an angiotensin-converting enzyme inhibitor (ACEi) and/or an angiotensin receptor blocker (ARB).