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Should We STOP Angiotensin Converting Enzyme Inhibitors/Angiotensin Receptor Blockers in Advanced Kidney Disease?

Aimun Ahmed1, Tom Jorna, Sunil Bhandari

  • 1Renal Department Royal Preston Hospital Lancashire Teaching Hospitals, Preston, UK.

Nephron
|June 24, 2016
PubMed

Insights

For advanced chronic kidney disease (CKD), the benefit of stopping angiotensin converting enzyme inhibitors (ACEi) or angiotensin II receptor antagonists (ARB) on estimated glomerular filtration rate (eGFR) is uncertain. The impact on cardiovascular outcomes remains debated.

Area of Science:

  • Nephrology
  • Cardiology
  • Pharmacology

Background:

  • Chronic kidney disease (CKD) is a global health issue linked to cardiovascular disease (CVD) and reduced quality of life.
  • Current strategies to preserve glomerular filtration rate (GFR) in CKD focus on blood pressure (BP) and proteinuria reduction.
  • Angiotensin converting enzyme inhibitors (ACEi) and angiotensin II receptor antagonists (ARB) are standard for early CKD, but their role in advanced CKD (eGFR ≤30 ml/min/1.73 m2) is unclear.

Purpose of the Study:

  • To review the current literature on the use of ACEi/ARB in advanced CKD.
  • To discuss controversies surrounding ACEi/ARB omission in advanced CKD patients.
  • To evaluate the balance between potential renal function gains and cardiovascular risks associated with ACEi/ARB therapy in advanced CKD.

Main Methods:

  • Literature review of studies addressing ACEi/ARB use in advanced CKD.
  • Discussion of existing evidence on BP management and cardiovascular outcomes in CKD.
  • Highlighting the ongoing STOP ACEi trial for further evidence.

Main Results:

  • While BP reduction benefits cardiovascular events, ACEi/ARBs are not demonstrably superior to other antihypertensives.
  • Limited evidence exists on the cardiovascular risk reduction benefits of ACEi/ARB therapy in advanced non-dialysis CKD.
  • The efficacy and safety of ACEi/ARB in advanced CKD remain subjects of ongoing research and debate.

Conclusions:

  • The optimal use of ACEi/ARB in advanced CKD requires further investigation.
  • The potential renal benefits of discontinuing ACEi/ARB must be weighed against potential cardiovascular risks.
  • The STOP ACEi trial is expected to provide crucial data on ACEi/ARB management in advanced CKD.

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