Discontinuation of RAS Inhibitors Associated with Exacerbated Outcomes in Patients with Chronic Kidney Disease-ScienceDaily

Small studies have suggested that a group of drugs called RAS inhibitors may be harmful to people with advanced chronic kidney disease, so doctors should discontinue treatment for such patients. Is often. Researchers at the Karolinska Institute have shown that discontinuing treatment reduces the risk of requiring dialysis, but also increases the risk of cardiovascular events and death.The results are published in Journal of the American Society of Nephrology..

Chronic kidney disease (CKD) affects about 10 percent of the world’s population. Hypertension is the most common comorbidity. Patients with CKD are at increased risk of cardiovascular disease and death.

Advanced chronic kidney disease is classified as “significant decline in renal function” and is defined as the ability of the kidneys to purify blood less than about 30 percent of normal in young adults. In some patients, CKD progresses and requires dialysis or transplantation as renal replacement therapy to extend lifespan.

Renin-angiotensin system inhibitors (RAS inhibitors), including both ACE inhibitors (ending in “pril”) and ARB (ending in “sartan”), are often used to treat hypertension, cardiovascular disease, heart failure, and CKD. It is a medicine that is used. However, this population was underestimated in a groundbreaking randomized trial, and its efficacy and safety in patients with advanced CKD are not fully understood.

“Small studies suggest that discontinuing RAS inhibitors in these patients may improve renal function and delay the need for renal replacement therapy,” said Leiden University Medical Center Clinic. Edouard Fu, MD and PhD candidates from the Department of Epidemiology said. First author. “But discontinuing these medications can also increase the risk of heart attack, stroke, and death. We wanted to help practitioners by assessing the risks and benefits of this decision, so the Swedish quality registration is this. Very good for answering questions. “

Researchers and collaborators at the Karolinska Institute conducted epidemiological studies using data from the Swedish renal registry and found more than 10,000 patients with progressive CKD who received RAS inhibitors over the last decade. I evaluated it.

Comparing the morbidity and mortality of patients who discontinued treatment with those who continued drug therapy, researchers found that discontinuing these medications reduced the risk of needing renal replacement therapy by 8%. Did.

However, discontinuation was also associated with a 13% higher risk of dying in 5 years and a 12% higher risk of suffering a heart attack or stroke.

“The use of RAS inhibitors in patients with advanced CKD is controversial and many physicians explain them,” said the lead study, a professor of medical epidemiology and biostatistics at the Karolinska Institute in Sweden. Said Juan Jesus Carrero. “Our results are more complex than discontinuing treatment on a regular basis, and doctors carefully weigh the protective effects of RAS inhibitors on the cardiovascular system with their potential harm to the kidneys. It indicates the need. Until clinical trials are conducted, this evidence is the continued use of this life-saving therapy in patients with advanced CKD who are successful with drug therapy. “

He points out that these medications may have to be discontinued for other reasons, for example, if the patient’s blood potassium levels are persistently high and they do not respond to management.

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Materials provided by Karolinska Institute.. Note: The content can be edited in style and length.

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