The following is a summary of “Association between Acute Declines in eGFR during Renin-Angiotensin System Inhibition and Risk of Adverse Outcomes,” published in the June 20204 issue of Nephrology by Ku et al.
The initiation of the renin-angiotensin system (RAS) has been commonly followed by a decline in glomerular filtration rate (GFR). However, the association between the two has not been clearly defined.
Researchers conducted a prospective study assessing how estimated GFR (eGFR) changes during RAS inhibitor trials relate to kidney health outcomes.
They recruited participants with CKD (eGFR<60 mL/min/1.73m2) from 16 trials of RAS inhibition trials. Percentage changes in eGFR from randomization to month 3 and month 1 were tracked. The primary outcome was kidney failure, needing replacement therapy. Cox models assessed the link between eGFR decline and kidney failure risk. Spline models identified the threshold of change in eGFR below which RAS inhibition was favorable.
The results showed 11,800 participants with mean eGFR 43 (SD 11) mL/min/1.73m2, median urine albumin/creatinine ratio of 362 mg/g (IQR 50, 1367) were included, and 1,162 (10%) developed kidney failure. The eGFR decline threshold favoring RAS inhibitors was up to 13% (95% CI: 8%-17%) over 3 months and 21% (95% CI: 15%-27%) over 1 month after starting RAS treatment.
Investigators concluded that smaller declines in eGFR within the first 3 months of RAS inhibitor treatment, ≤ 13%, or within 1 month, ≤ 21%, were linked to reduced risk of kidney failure compared to no decline with placebo or other treatments.
Source: journals.lww.com/jasn/abstract/9900/association_between_acute_declines_in_estimated.354.aspx
