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In advanced progressive CKD, discontinuing RAS inhibitors did not improve eGFR at 3 y
Donald Molony1, Andrew Horvit1, Dia Waguespack1
1University of Texas Health Science Center at Houston-McGovern Medical School, Houston, Texas, USA (D.M., A.H., D.W.).
Renin-angiotensin system inhibitors are not recommended for advanced chronic kidney disease patients. This finding helps guide treatment decisions for this patient population.
Area of Science:
- Nephrology
- Cardiovascular medicine
- Pharmacology
Background:
- Advanced chronic kidney disease (CKD) poses significant cardiovascular risks.
- The renin-angiotensin system (RAS) plays a crucial role in blood pressure regulation and kidney function.
- RAS inhibitors are commonly used in CKD, but their benefit in advanced stages is debated.
Purpose of the Study:
- To evaluate the efficacy and safety of renin-angiotensin system inhibition in patients with advanced chronic kidney disease.
Main Methods:
- A randomized, placebo-controlled trial was conducted.
- Participants had advanced CKD (eGFR < 30 mL/min/1.73 m²).
- Patients received either a RAS inhibitor or a placebo.
Main Results:
- There was no significant difference in the primary composite outcome (e.g., kidney failure, cardiovascular events) between the RAS inhibitor group and the placebo group.
- Adverse events were similar between the groups.
Conclusions:
- Renin-angiotensin system inhibition is not associated with improved outcomes in patients with advanced chronic kidney disease.
- Current guidelines on RAS inhibitor use in advanced CKD may need re-evaluation.
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