Patients with advanced chronic kidney disease should keep taking RAS inhibitors
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Patients with chronic kidney disease (CKD) should continue taking renin-angiotensin system (RAS) inhibitors unless doctors see a specific reason to stop, according to new research published in the Journal of the American Society of Nephrology.
Some smaller studies have suggested that RAS inhibitors can be damaging to advanced CKD patients. The team behind this latest research, however, found that stopping RAS inhibitor therapy can increase a patient’s risk of death or other significant cardiovascular outcomes.
The authors tracked data from more than 10,000 patients who developed CKD while undergoing RAS inhibitor therapy. All information came from the Swedish Renal Registry, and patients received care from 2007 to 2017.
Overall, stopping RAS inhibitor therapy was associated with a higher absolute 5-year risk of death (54.5% vs. 40.9%) and major adverse cardiovascular events (59.5% vs. 47.6%). The risk of initiating kidney replacement therapy, however, increased among patients who stopped RAS inhibitor therapy.
“The use of RAS inhibitors in patients with advanced CKD is controversial, and many doctors deprescribe them,” principal investigator Juan Jesus Carrero, MD, PharmD, PhD, a professor at Sweden’s Karolinska Institute, said in a statement. “Rather than routinely discontinuing treatment, our results show that the issue is a complex one and that doctors must carefully weigh the protective effects of RAS inhibitors on the cardiovascular system against the potential harms on the kidneys. Until clinical trials are performed, this evidence supports continued use of this lifesaving therapy in patients with advanced CKD who are doing well on the medications.”
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Michael has more than 18 years of experience as a professional writer and editor. He has written at length about cardiology, radiology, artificial intelligence and other key healthcare topics.