Document Detail


The impact of stopping inhibitors of the renin-angiotensin system in patients with advanced chronic kidney disease.
MedLine Citation:
PMID:  19820248     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Inhibition of the renin-angiotensin-aldosterone system (RAAS) has shown to slow chronic kidney disease (CKD) progression. This is most notable at the earlier stages of diabetic and proteinuric nephropathies. Objective. Here, we observed the impact of discontinuation of angiotensin converting enzyme inhibitors (ACEi)/angiotensin receptors blockers (ARB) in patients with advanced kidney disease.
METHODS: 52 patients (21 females and 31 males) with advanced CKD (stages 4 and 5), who attended our low clearance clinic (LCC) in preparation for renal replacement therapy (RRT). Mean age was 73.3 ± 1.8 years with an estimated glomerular filtration rate (eGFR) of 16.38 ± 1 ml/min/1.73 m(2). Baseline urine protein:creatinine ratio (PCR) was 77 ± 20 mg/mmol. 46% suffered from diabetes mellitus. Patients were followed for at least 12 months before and after ACEi/ARB were stopped.
RESULTS: 12 months after discontinuation of ACEi/ARB eGFR increased significantly to 26.6 ± 2.2 ml/min/ 1.73 m(2) (p = 0.0001). 61.5% of patients had more than a 25% increase in eGFR, whilst 36.5% had an increase exceeding 50%. There was a significant decline in the eGFR slope -0.39 ± 0.07 in the 12 months preceding discontinuation. The negative slope was reversed +0.48 ± 0.1 (p = 0.0001). Mean arterial blood pressure (MAP) increased from 90 ± 1.8 mmHg to 94 ± 1.3 mmHg (p = 0.02), however ≥50% of patients remained within target. Overall proteinuria was not affected (PCR before = 77 ± 20 and after = 121.6 ± 33.6 mg/mmol).
CONCLUSION: Discontinuation of ACEi/ARB has undoubtedly delayed the onset of RRT in the majority of those studied. This observation may justify a rethink of our approach to the inhibition of the RAAS in patients with advanced CKD who are nearing the start of RRT.
Authors:
Aimun K Ahmed; Neetha S Kamath; Mohsen El Kossi; A Meguid El Nahas
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Publication Detail:
Type:  Journal Article     Date:  2009-10-10
Journal Detail:
Title:  Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association     Volume:  25     ISSN:  1460-2385     ISO Abbreviation:  Nephrol. Dial. Transplant.     Publication Date:  2010 Dec 
Date Detail:
Created Date:  2010-11-24     Completed Date:  2011-04-18     Revised Date:  2011-08-12    
Medline Journal Info:
Nlm Unique ID:  8706402     Medline TA:  Nephrol Dial Transplant     Country:  England    
Other Details:
Languages:  eng     Pagination:  3977-82     Citation Subset:  IM    
Affiliation:
Sheffield Kidney Institute, Northern General Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK.
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MeSH Terms
Descriptor/Qualifier:
Aged
Angiotensin Receptor Antagonists / contraindications*
Angiotensin-Converting Enzyme Inhibitors / contraindications*
Blood Pressure / physiology
Chronic Disease
Disease Progression*
Female
Glomerular Filtration Rate / physiology
Humans
Kidney Diseases / physiopathology*,  prevention & control*,  therapy
Kidney Failure, Chronic / physiopathology,  therapy
Male
Proteinuria / physiopathology
Renal Replacement Therapy
Renin-Angiotensin System / physiology*
Retrospective Studies
Withholding Treatment*
Chemical
Reg. No./Substance:
0/Angiotensin Receptor Antagonists; 0/Angiotensin-Converting Enzyme Inhibitors
Comments/Corrections
Comment In:
Nephrol Dial Transplant. 2011 Jul;26(7):2413; author reply 2413-4   [PMID:  21592977 ]
Nephrol Dial Transplant. 2011 May;26(5):1752-3; author reply 1753   [PMID:  21471329 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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