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Updated: Sep 20, 2025
A Large Animal Model for Acute Kidney Injury by Temporary Bilateral Renal Artery Occlusion
Published on: February 2, 2021
Stopping kidney protection in the elderly following acute kidney injury: think mortality
1Department of Nephrology and Hypertension, IIS-Fundacion Jimenez Diaz, Madrid, Spain.
Insights
Stopping renin-angiotensin system (RAS) blockers after acute kidney injury (AKI) in elderly patients increased mortality risk. Continued RAS blockade may be safer for long-term kidney and cardiovascular health.
Area of Science:
- Nephrology
- Cardiology
- Geriatrics
Background:
- Chronic kidney disease (CKD) is a growing global health concern, linked to premature mortality.
- Nephroprotective medications like renin-angiotensin system (RAS) blockers are often discontinued after acute kidney injury (AKI), despite their benefits in reducing glomerular hyperfiltration.
- Previous evidence on the consequences of stopping RAS blockers post-AKI has been inconsistent.
Discussion:
- This study investigated the practice of stopping RAS blockers in elderly patients (median age 78) who survived moderate to severe AKI.
- Approximately 50% of patients stopped RAS blockade within 3 months of hospital discharge.
- The study analyzed the impact on subsequent health events, including mortality, cardiovascular events, and kidney-related outcomes.
Key Insights:
- Stopping RAS blockade post-AKI was associated with a significantly increased risk of a composite outcome including death, myocardial infarction, and stroke, with deaths constituting 80% of events.
- Conversely, discontinuing RAS blockers led to a reduced risk of hyperkalemia.
- The risks of recurrent AKI, CKD progression, or heart failure hospitalization remained unchanged in patients who stopped RAS blockers.
Outlook:
- Findings challenge the current practice of routinely stopping RAS blockers long-term after AKI.
- Further research is warranted to re-evaluate similar practices concerning sodium-glucose transport protein 2 (SGLT2) inhibitors post-AKI.
- This study highlights the need for personalized treatment strategies in managing patients with CKD and AKI history.
Abstract:
Chronic kidney disease (CKD) is projected to become the fifth most common global cause of death by 2040. This illustrates a key consequence of CKD, i.e. premature mortality. Since nephroprotective drugs such as renin-angiotensin system (RAS) blockers and sodium-glucose transport protein 2 (SGLT2) inhibitors decrease glomerular hyperfiltration, they may be stopped following an episode of acute kidney injury (AKI). This may theoretically modify the risks of subsequent events, ranging from hyperkalaemia to CKD progression to cardiovascular events, but the evidence so far has been inconsistent. Roemer et al. have now addressed the shortcomings of prior studies. In a population of mostly elderly (median age 78 years) prevalent users of RAS blockers with an indication for this therapy and who survived for at least 3 months after discharge following a hospitalization characterized by moderate to severe AKI, roughly 50% had stopped RAS blockade at 3 months. Stopping RAS blockade was associated with an increased risk of a primary composite outcome of death, myocardial infarction and stroke, of which a large majority (80%) of events were deaths. In contrast, the risk of hyperkalaemia was reduced and the risk of repeated AKI, CKD progression or heart failure hospitalization was unchanged in patients who stopped RAS blockers. These findings call for a re-evaluation of the practice of stopping RAS blockers in the long-term following AKI and suggest that studies are needed regarding similar practices for SGLT2 inhibitors.
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