Discontinuation of RAS inhibitors associated with risk of adverse outcomes in patients with chronic kidney disease

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.But not enough about them Effectiveness This population was underestimated in a groundbreaking randomized trial, so the safety and safety of patients with advanced CKD.

“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. Lead author of Edouard Fu, MD and PhD candidates in the Faculty of Epidemiology. “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 morbidity and mortality in patients who discontinued treatment and 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 doctors do not explain them. Our results are complex, rather than discontinuing treatment on a regular basis, requiring physicians to carefully weigh the protective effects of RAS inhibitors on the cardiovascular system with their potential harm to the kidneys. Indicates that there is. Until clinical trials are conducted, this evidence supports the continued use of this life-saving therapy in patients with advanced CKD who are successful with medication. “

Juan Jesus Carrero, Principal Investigator, Professor, Faculty of Medical Epidemiology and Biostatistics, Karolinska Institute, Sweden

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.

The study was conducted in collaboration with Leiden University Medical Center (Netherlands), McMaster University (Canada), and London School of Hygiene and Tropical Medicine (UK). It was supported by grants from the Swedish Research Council, the Swedish Cardiopulmonary Foundation, and the Westman Foundation. Some authors have received funding and rewards from pharmaceutical companies for issues unrelated to this study. Scientific treatises fully describe potential conflicts of interest.