- Question
- In patients with advanced, progressive chronic kidney disease, does discontinuing renin-angiotensin system (RAS) inhibitors (ACE inhibitors/ARBs) improve or slow the decline in estimated glomerular filtration rate (eGFR) compared with continuing them?
- Design
- Multicenter, open-label, randomized trial of 411 patients assigned to discontinue or continue RAS inhibitor therapy. Prespecified subgroups were defined by age, eGFR, type of diabetes, mean arterial pressure and proteinuria.
- Population
- Patients with advanced and progressive chronic kidney disease, with eGFR below 30 ml/min/1.73 m2, receiving RAS inhibitors.
- Intervention
- Discontinuation of RAS inhibitor therapy (ACE inhibitor or ARB).
- Control
- Continuation of RAS inhibitor therapy.
- Primary outcome
- eGFR at 3 years, excluding values obtained after the start of renal-replacement therapy.
- Results
- At 3 years the least-squares mean eGFR was 12.6 ml/min/1.73 m2 in the discontinuation group and 13.3 in the continuation group (difference -0.7; 95% CI -2.5 to 1.0; P = 0.42). ESKD or initiation of renal-replacement therapy occurred in 128 patients (62%) with discontinuation and 115 (56%) with continuation (HR 1.28; 95% CI 0.99 to 1.65). No heterogeneity was seen across the prespecified subgroups.
- Safety
- Adverse events were similar between groups: cardiovascular events 108 vs. 88 and deaths 20 vs. 22 (discontinuation vs. continuation).
- Conclusion
- In advanced, progressive chronic kidney disease, discontinuing RAS inhibitors did not produce a significant difference in the long-term decline in eGFR compared with continuing them.
- Why it matters
- The trial did not support routinely stopping RAS inhibitors in advanced kidney disease to preserve kidney function, allowing their known cardiovascular and renal benefits to be maintained.
Card generated automatically with AI from the abstract of the original publication and the trial registry; every figure was checked against those sources. It may contain errors: verify the data at the source before using it for clinical decisions.
Generated on October 15, 2026