Treatment with a RAS inhibitor is widely accepted as standard practice for slowing progression of CKD, but data have been inconsistent as to whether there is benefit to continuing RAS inhibition when patients develop advanced CKD. KidneyWk
Asked to comment, Janani Rangaswami, MD, who was not involved with the study, said:"The message from STOP ACEi is that there is no harm continuing RAS inhibitor treatment, so when feasible continue treatment" even when a patient's eGFR drops below 30 mL/min/1.73m"There has been a perception among nephrologists of harm from RAS inhibitors in these patients because they can cause hyperkalemia and may not help with CKD progression once eGFR is less than 30 mL/min/1.
"Current guidelines do not provide specific advice on whether to continue or stop ACE inhibitors or ARBs for advanced chronic kidney disease," they also note. In addition to the primary outcome, 62% of patients who stopped RAS inhibitor treatment and 56% of those who continued developed end-stage kidney disease or required renal-replacement therapy, which translated into an adjusted hazard ratio of 1.28 for this outcome among those who discontinued compared with those who continued, which was just short of significance .
Those who discontinued RAS-inhibitor treatment could receive any guideline-recommended antihypertensive agent that was not a RAS inhibitor, although adding a RAS inhibitor was permitted as a last treatment resort.
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