title: Stopping renin-angiotensin system inhibitors in chronic kidney disease: predictors of response.
abstract: Renin-angiotensin system (RAS) inhibitors are considered first-line agents for hypertensive patients with progressive chronic kidney disease (CKD). In a previous study, we showed that stopping RAS inhibitors increased estimated glomerular filtration rate (eGFR) in a significant number of advanced CKD patients. The present study tries to address who would benefit and whether this benefit is predictable.
  
  
  
  Forty-three CKD stage 4 patients had RAS inhibitors stopped and were followed for at least 24 months. Compared outcome groups were 'alive', 'renal replacement therapy (RRT)' or 'died'. Improvement in eGFR was used in a receiver-operating characteristic curve and finds the best predictor for surviving without RRT.
  
  
  
  Patients who survived without RRT were all hypertensive and had a higher eGFR increment after stopping the drugs. Those with eGFR improvement ≥5 ml/min/1.73 m(2) were the most likely to survive long term without RRT (log-rank test, p = 0.03). They had a significant increment in blood pressure that correlated with eGFR improvement (r = 0.403, p = 0.013).
  
  
  
  A significant increase in eGFR after stopping RAS inhibitors suggests that long-term survival without RRT is more likely. Our findings question the universal preemptive indication of RAS inhibitors in advanced CKD and suggest that they can be safely stopped, at least in some patients.
authors.affiliation: Department of Medicine, University of Joinville Region – Univille, Joinville, Brazil. anderson.roman@univille.edu.br
authors.forename: Anderson Roman
authors.initials: AR
authors.lastname: Gonçalves
authors.forename: Arif
authors.initials: A
authors.lastname: Khwaja
authors.forename: Aimun K
authors.initials: AK
authors.lastname: Ahmed
authors.forename: Mohsen
authors.initials: M
authors.lastname: El Kossi
authors.forename: Meguid
authors.initials: M
authors.lastname: El Nahas
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D047228:Angiotensin II Type 1 Receptor Blockers / Q000008:administration & dosage* / Q000009:adverse effects / Q000627:therapeutic use; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000008:administration & dosage* / Q000009:adverse effects / Q000627:therapeutic use; D000959:Antihypertensive Agents / Q000008:administration & dosage* / Q000009:adverse effects / Q000627:therapeutic use; D002908:Chronic Disease; D003404:Creatinine / Q000097:blood; D003928:Diabetic Nephropathies / Q000150:complications / Q000188:drug therapy / Q000628:therapy; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D006801:Humans; D006947:Hyperkalemia / Q000139:chemically induced; D006973:Hypertension / Q000150:complications / Q000188:drug therapy*; D053208:Kaplan-Meier Estimate; D007674:Kidney Diseases / Q000150:complications* / Q000503:physiopathology / Q000628:therapy; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012372:ROC Curve; D012084:Renin-Angiotensin System / Q000187:drug effects*; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D047228:Angiotensin II Type 1 Receptor Blockers; D000806:Angiotensin-Converting Enzyme Inhibitors; D000959:Antihypertensive Agents; D003404:Creatinine