ACE and stage 5 chronic kidney disease: Despite multifactorial treatments that include glycemic, lipid, and blood pressure control (4), renin-angiotensin system inhibitors including angiotensin-converting enzyme inhibitors (5) and angiotensin receptor blockers (6), peroxisome proliferator-activated receptor agonists (7), PKC antagonist (8), the angiotensin-converting enzyme inhibitor pyridoxamine (9), and endothelin receptor inhibitors like atrasentan (10), DN is the main cause of end-stage renal disease (ESRD) with a high disability and mortality in western countries.