Related Experiment Video
Updated: May 25, 2025

A Modified Two Kidney One Clip Mouse Model of Renin Regulation in Renal Artery Stenosis
Published on: October 26, 2020
Impact of Renin-Angiotensin-Aldosterone System Inhibition on Advanced Chronic Kidney Disease Progression: A
Lukas Westermann1, Janis M Nolde2, Johannes Wiegel2
1Department of Medicine IV, Medical Center, Faculty of Medicine University of Freiburg, Freiburg im Breisgau, Germany, lukas.westermann@uniklinik-freiburg.de.
Introduction:
Maintaining renin-angiotensin-aldosterone system inhibition (RAASi) in advanced chronic kidney disease (CKD) to delay CKD progression is still controversial. This is due to potential side effects associated with RAASi, such as a decline in glomerular filtration rate (GFR) and hyperkalemia. This study aimed to examine the effect of RAASi on progression of advanced CKD to kidney failure (estimated glomerular filtration rate [eGFR] <15 mL/min/1.73 m2, CKD stage 5) in a real-life outpatient cohort.
Methods:
This single-center retrospective observational study presents data from 954 individuals with advanced CKD (eGFR 15-30 mL/min/1.73 m2), comparing 806 RAASi with 511 control intervals over a median follow-up period of 19 months. The endpoint was defined as time to manifestation of kidney failure. Univariate and multivariate time-to-event analyses were performed to assess effects of RAASi on endpoint probabilities.
Results:
Univariate time-to-event analysis did not show a significant difference in the median time to kidney failure between RAASi and control intervals (7.6 vs. 7.0 years, p = 0.74). Covariate-adjusted multivariate regression models also demonstrated no association between RAASi treatment and progression to kidney failure in patients with advanced CKD (hazard ratio 0.92 [95% CI: 0.67-1.23], p = 0.63).
Conclusion:
RAASi has no significant impact on the time to kidney failure in patients with advanced CKD. Hence, this study supports maintenance of RAASi in advanced CKD, if used for extrarenal indications such as cardiovascular protection.
Related Concept Videos
Antihypertensive Drugs: Direct Renin Inhibitors
Heart Failure Drugs: Inhibitors of Renin-Angiotensin System
Hormonal Regulation
Antihypertensive Drugs: Angiotensin-Converting Enzyme Inhibitors
Factors Affecting Renal Clearance: Renal Impairment
One condition associated with renal failure is uremia. Uremia is characterized by impaired glomerular filtration and fluid accumulation in the body. This condition hinders the renal clearance of drugs, resulting in drug accumulation and potential...
Antihypertensive Drugs: Angiotensin II Receptor Blockers

