RAS inhibitor discontinuation of no help in slowing kidney decline

Stopping treatment with renin–angiotensin system (RAS) inhibitors in patients with advanced chronic kidney disease does not appear to raise the levels of estimated glomerular filtration rate (eGFR) or decelerate its decline, according to a study.

The study included 441 patients with advanced and progressive chronic kidney disease (eGFR, <30 ml per minute per 1.73 m² of body-surface area). They were randomized to either discontinue or continue therapy with RAS inhibitors.

The primary endpoint of the eGFR at 3 years was 12.6 ml per minute per 1.73 m² in the discontinuation group and 13.3 ml per minute per 1.73 m² in the continuation group (difference, −0.7, 95 percent confidence interval [CI], −2.5 to 1.0; p=0.42). There was no heterogeneity in outcome in terms of the prespecified subgroups examined.

Meanwhile, a total of 128 patients (62 percent) in the discontinuation group and in 115 (56 percent) in the continuation group developed end-stage kidney disease or initiated renal-replacement therapy (hazard ratio, 1.28, 95 percent CI, 0.99–1.65).

In terms of safety, there was no significant difference between the discontinuation group and continuation group in terms of the frequency of adverse events, including cardiovascular events (108 vs 88) and deaths (20 vs 22).