Discontinuation of RAS Inhibition After an Acute Decline in Estimated Glomerular Filtration Rate

Area of Science:

• Nephrology
• Cardiology
• Pharmacology

Background:

• Renin-angiotensin system inhibitors (RASIs) are crucial for slowing chronic kidney disease (CKD) progression.
• Acute declines in estimated glomerular filtration rate (eGFR) often lead to RASI discontinuation.
• This practice may negatively impact patient outcomes.

Purpose of the Study:

• To investigate the risks of cardiovascular, kidney, and mortality outcomes associated with discontinuing versus continuing RASIs.
• To analyze outcomes in patients experiencing an acute eGFR decline after RASI initiation.

Main Methods:

• Retrospective cohort study using electronic health records and vital statistics from Manitoba, Canada.
• Target trial emulation with propensity score matching for adults initiating RASIs with >15% eGFR decline within 90 days.
• Primary outcomes: end-stage kidney disease (ESKD) or death; Secondary outcomes: major adverse cardiovascular events (MACEs) or acute kidney injury (AKI) at 180 days.

Main Results:

• A total of 4233 patients were analyzed; 33.3% discontinued RASIs.
• Discontinuation was associated with a significantly higher risk of death (HR, 1.23) and ESKD (HR, 1.74).
• No significant difference in MACEs or AKI risk was observed between groups.

Conclusions:

• Discontinuing RASIs following an acute eGFR decline is linked to increased risks of ESKD and death.
• Further research is needed to understand reasons for RASI discontinuation.
• Strategies to improve RASI persistence are warranted for better patient management.