Discontinuation of RAS Inhibition After an Acute Decline in Estimated Glomerular Filtration Rate

Should renin-angiotensin system inhibitors (RASIs) be discontinued after an acute decline in eGFR?This cohort study using a target trial emulation approach in 4233 patients who initiated RASI and had a greater than 15% decline in eGFR found that those who discontinued RASIs had a higher risk of end-stage kidney disease and death compared with those who continued RASIs. There was no association between RASI discontinuation and the risk of major adverse cardiovascular events or acute kidney injury.These findings suggest that further study is needed to understand reasons for frequent discontinuation of RASIs and devise strategies to improve their persistent use.

Corresponding Author: Mark J. Sarnak, MD, MS, Division of Nephrology, Tufts Medical Center, 800 Washington St, Box 391, Boston, MA 02111 (msarnak@tuftsmedicalcenter.org).

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