Discontinuation of renin–angiotensin system inhibitors brings no benefits in severe chronic kidney disease

The STOP ACEi 1 is a multi-centre, open-label, randomized trial funded by the United Kingdom National Institute for Health Research and Medical Research Council, which assessed whether the discontinuation of renin-angiotensin system (RAS) inhibitors would increase or stabilize the estimated glomerular filtration rate (eGFR) in patients with progressive stage 4 or 5 chronic kidney disease (CKD) with eGFR 18 years were eligible if they were not receiving dialysis and had not undergone kidney transplantation, if they had a decrease of >2 mL/min/1.73m 2 per year in the eGFR during the previous 2 years and if they were receiving treatment with an angiotensin-converting enzyme (ACE) inhibitor, an angiotensin receptor blocker (ARB), or both for more than 6 months.Exclusion criteria included uncontrolled hypertension or a history of myocardial infarction or stroke within the previous 3 months.Patients were randomly assigned in a 1:1 ratio either to discontinue or to continue RAS inhibitors.• The primary outcome was the eGFR at 3 years calculated according to the Modification of Diet in Renal Disease (MDRD) study, as updated in 2005 (MDRD175).• Secondary outcomes included the time until the development of end-stage kidney disease (ESKD); a composite of a decrease of >50% in the eGFR, the development of ESKD, or the initiation of renal replacement therapy; hospitalization for any cause; measures of cystatin C and blood pressure (BP); quality of life; and exercise capacity assessed by the 6-min walk test; cardiovascular events and death.• The study randomized a total of 411 patients (206 in the discontinuation group and 205 in the continuation group) with a median age of 63 years and a greater proportion of male (68%) and white (85%) subjects.The median eGFR at baseline was 18 mL/min/1.73m 2 and ∼30% of patients had eGFR 50% in the eGFR was 68% in the discontinuation group and 63% in the continuation group (adjusted relative risk RR, 1.07; 95% CI, .94-1.22).There were no significant differences between the discontinuation and continuation groups in the numbers of hospitalizations for any reason (414 vs. 413), cardiovascular events (108 vs. 88), and death (20 vs. 22).The numbers of serious adverse cardiovascular, vascular, and heart failure events were also similar in the two groups.