Study shows no detrimental impact of continuing cardiac drugs with advanced CKD
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ORLANDO — Patients with chronic kidney disease did not see a change in kidney function when clinicians continued a course of angiotensin-converting enzyme inhibitors and angiotensin receptor blockers, according to a study presented here.
Sunil Bhandari, MB, ChB, FRCPE, PhD, M Clin Edu FHEA, and colleagues from the United Kingdom reviewed the impact of discontinuing use of angiotensin-converting enzyme inhibitors (ACEi) and angiotensin receptor blockers (ARBs) in patients with advanced CKD. “ACEi and ARBs slow progression of mild to moderate chronic kidney disease (CKD),” Bhandari and colleagues wrote in a poster presentation. “However, small studies have reported delayed progression in patients with advanced CKD after discontinuation of ACEi/ARBs.”
“We assessed whether discontinuation of ACEi/ARBs could slow progression of CKD in patients with advanced CKD in the STOP-ACEi trial,” they wrote.
In the open-label, multicenter, randomized controlled trial, adults with CKD stage 4 to 5 received ACEi and/or ARBs at 37 dialysis clinics in the U.K. Patients were randomized 1:1 to either discontinue or continue ACEi/ARBs and were stratified based on age, baseline eGFR, diabetes, blood pressure and proteinuria, according to the poster.
The primary endpoint of the study was kidney function at 3 years. Secondary outcome measures included the number of patients starting renal replacement therapy and/or seeing a greater than 50% decline in eGFR, quality of life/well-being, hospitalization rates and safety measures including cardiovascular event rates and mortality. The study was conducted between July 2014 and June 2018. There were 411 patients recruited for the study.
Results showed that patients who remained on the ACEi and ARBs did not see a decline in kidney function.
“We know there is a cardiovascular benefit for patients with CKD who take ACEis and ARBs, but small studies have reported that discontinuing them resulted in the eGFR going up,” Bhandari told Healio. “We know that continuing ACE and ARB has a cardiovascular benefit.”
While the study did not look at cardiovascular benefit in the study group, “there was no detriment,” Bhandari said. “There was no [increase] in death” when compared with the control group, he said.
“What was interesting was there were fewer events by continuing with the ACEs and ARBs in the advanced CKD patients, including the need for kidney dialysis or greater than a 50% drop in kidney function,” Bhandari told Healio.
“The results of this trial will inform future clinical practice worldwide and guideline recommendations,” Bhandari and colleagues wrote.
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Bhandari S, et al. Poster TH-PO966. Presented at: ASN Kidney Week; Nov. 3-6, 2022; Orlando (hybrid meeting).
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