The decision to stop renin-angiotensin system (RAS) inhibitor therapy in patients with advanced chronic kidney disease (CKD) should take into account both cardiovascular risk and the risk for kidney replacement therapy, according to a study published in the Journal of the American Society of Nephrology. Researchers assessed whether outcomes are affected by stopping RAS inhibitor therapy in patients with advanced CKD. The Swedish Renal Registry (2007 to 2017) was used to identify 10,254 nephrologist-referred patients (median age, 72; 36% women) who reached advanced CKD (estimated glomerular filtration rate [eGFR] <30 mL/min/1.73 m2) while on RAS inhibitor therapy. The researchers found that 15% of patients stopped RAS inhibitors within 6 months. Compared with continuing therapy, stopping RAS inhibitors was associated with a higher absolute 5-year risk for death (40.9% vs 54.5%) and major adverse cardiovascular events (47.6% vs 59.5%) and a lower risk for kidney replacement therapy (36.1% vs 27.9%). Whether patients stopped at higher or lower eGFR, after adjustment and stratification for albuminuria and potassium, and when modeling RAS inhibition as a time-dependent exposure using a marginal structural model, results remained consistent across prespecified subgroups.
