Key result
Discontinuing RAS inhibitors fails to improve 3-year eGFR in advanced progressive CKD.
Why the study?
Although RAS inhibitors slow CKD progression and lower blood pressure and proteinuria, their safety and nephroprotective effects in advanced CKD remain uncertain.
Absolute Event Rate: 13.3% vs 12.6%
p-value: p=0.42
Discontinuing RAS inhibitors yields no eGFR benefit at 3 years in advanced CKD; leaves open effects on ESKD and cardiovascular risk.
Renin-angiotensin system (RAS) inhibitors have been the preferred antihypertensive agents in the setting of chronic kidney disease (CKD) since the 1990s. Their use has been consistently demonstrated to slow the progression of kidney disease, along with beneficial blood pressure and proteinuria lowering effects.1-5 Although RAS blockade is a pillar of proteinuric CKD management, questions remain around whether they can be safely continued in patients with advanced CKD and whether they remain nephroprotective in later stages of the disease.
No takes yet. Share an insight, caveat, or question.
Thanabalasingam et al. (2023) conducted an editorial in Stage 4-5 Chronic Kidney Disease (CKD) (n=411). Discontinuation of renin-angiotensin system (RAS) inhibitors vs. Continuation of RAS inhibitors was evaluated on Estimated glomerular filtration rate (eGFR) at 3 years (p=0.42). Discontinuing renin-angiotensin system inhibitors in patients with advanced and progressive chronic kidney disease did not significantly improve estimated glomerular filtration rate at 3 years compared to continuing therapy.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: