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Evaluation of the stopping angiotensin converting enzyme inhibitor compared to angiotensin receptor blocker (STOP ACEi trial) in advanced and progressive chronic kidney disease.
Bhandari, Sunil; Mehta, Samir; Khawaja, Arif; Cleland, John G F; Ives, Natalie; Cockwell, Paul.
Afiliación
  • Bhandari S; Department of Renal Medicine, Hull University Teaching Hospitals NHS Trust, and Hull York Medical School, East Yorkshire, UK. Electronic address: sunil.bhandari@nhs.net.
  • Mehta S; Birmingham Clinical Trials Unit, University of Birmingham, Birmingham, UK.
  • Khawaja A; Department of Nephrology, Sheffield Kidney Institute, Sheffield, UK.
  • Cleland JGF; British Heart Foundation Centre of Research Excellence, School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK.
  • Ives N; Birmingham Clinical Trials Unit, University of Birmingham, Birmingham, UK.
  • Cockwell P; Department of Renal Medicine, Queen Elizabeth Hospital, Birmingham, UK.
Kidney Int ; 105(1): 200-208, 2024 Jan.
Article en En | MEDLINE | ID: mdl-37783444
In the STOP-ACEi trial, the outcome was similar whether or not renin-angiotensin system inhibitors (RASi) were discontinued. We now investigate whether the effect of withdrawing angiotensin converting enzyme inhibitors (ACEi) or angiotensin-receptor blockers (ARBs) differed. In this open label trial patients with estimated glomerular filtration rates (eGFR) under 30ml/min per 1.73 m2 and progressive chronic kidney disease (CKD) were randomized to stop or continue RASi. The primary outcome was eGFR at three years. The composite of kidney failure, over 50% fall in eGFR, or kidney replacement therapy (KRT) was also assessed. Of patients randomized, 99 stopped and 123 patients continued ACEi while 104 stopped and 77 continued ARB at baseline. At three years, the eGFR was similar whether or not patients were withdrawn from ACEi or from ARB. Kidney failure or initiation of KRT occurred in 65% of those stopping and 54% continuing ACEi (hazard ratio if stopped, 1.52; 95% Confidence Interval, 1.07 to 2.16) and in 60% on an ARB regardless of randomized group (hazard ratio if stopped, 1.23; 0.83 to 1.81). Kidney failure/Initiation of KRT with over 50% decline in eGFR occurred in 71% of those stopping and 59% continuing ACEi (relative risk if stopped, 1.19; 95% CI, 1.00 to 1.41) and in 65% stopping and 69% continuing ARB (relative risk if stopped, 0.96; 0.79 to 1.16). Thus, neither discontinuing ACEi nor ARB slowed the rate of decline in eGFR. Although discontinuation of ACEi appeared to have more unfavorable effects on kidney outcomes than stopping ARB, the trial was neither designed nor powered to show differences between agents.
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Texto completo: 1 Bases de datos: MEDLINE Asunto principal: Insuficiencia Renal Crónica / Antagonistas de Receptores de Angiotensina Tipo de estudio: Clinical_trials / Etiology_studies Límite: Humans Idioma: En Revista: Kidney Int Año: 2024 Tipo del documento: Article

Texto completo: 1 Bases de datos: MEDLINE Asunto principal: Insuficiencia Renal Crónica / Antagonistas de Receptores de Angiotensina Tipo de estudio: Clinical_trials / Etiology_studies Límite: Humans Idioma: En Revista: Kidney Int Año: 2024 Tipo del documento: Article