Introduction:
Among individuals with impaired kidney function, whether and when angiotensin-converting enzyme inhibitors (ACE-I) and angiotensin II receptor blockers (ARB) should be discontinued is unclear. We investigated the associations of ACE-I/ARB discontinuation with end-stage kidney disease (ESKD), major adverse cardiovascular events (MACE), and mortality in individuals who had an eGFR decline to below 30 ml/min/1.73m
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.
Hypothesis:
Patients with ACE-I/ARB discontinuation after an eGFR decline to below 30 ml/min/1.73m
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are at higher risks of ESKD, MACE, and mortality.
Methods:
Using electronic health records data from the Geisinger Health System, we identified individuals who initiated ACE-I/ARB between 01/01/2004 and 02/28/2019 and had an eGFR decline to below 30 ml/min/1.73m
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. We classified patients based on whether they discontinued ACE-I/ARB within six months following the eGFR decline. We assessed the associations of ACE-I/ARB discontinuation with ESKD, MACE, and mortality over the subsequent five years in a propensity-score matched sample.
Results:
Among the 3879 patients who met eligibility criteria, 1219 discontinued ACE-I/ARB within six months after eGFR decline to below 30 ml/min/1.73m
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. The propensity-score matched sample contained 1190 patients under each arm. ACE-I/ARB discontinuation was associated with higher risks of mortality (hazard ratio (HR): 1.45 [95% confidence interval (CI): 1.26-1.67]) and MACE (HR: 1.37 [95% CI: 1.20-1.57]), but no significant difference in risk of ESKD (HR: 1.31 [95% CI: 0.95-1.81]). Similar patterns held when evaluating ACE-I/ARB discontinuation following a 40% or greater decline in eGFR within a year.
Conclusions:
Our findings suggest there may be benefits of continued use of ACE-I/ARB in individuals who had an eGFR decline to below 30 ml/min/1.73m
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.
Cardiopulmonary exercise testing (CPET) in patients with end-stage kidney disease (ESKD): principles, methodology and clinical applications of the optimal tool for exercise tolerance evaluation
