In particular for older people, declining renal function poses an important clinical consideration with respect to the possibility of continuing treatment with angiotensin-converting enzyme inhibitor (ACE-I) and angiotensin II receptor blocker (ARB) treatment in the context of low estimated glomerular filtration rate (eGFR). A recently published study has examined whether discontinuation of these drugs after eGFR decreases to below 30 mL/min/1.73 m2 influences the risk of mortality, major adverse cardiovascular events (MACE), and end-stage kidney disease (ESKD). The study cohort consisted of 3909 patients treated with ACE-I or ARB therapy and had an eGFR decrease to below 30 mL/min/1.73 m2 during therapy, with extended follow-up. Those studied were classified based on whether they discontinued ACE-I or ARB therapy within 6 months after an eGFR decrease to below 30 mL/min/1.73 m2.
Of the 3909 individuals receiving ACE-I or ARB treatment who experienced an eGFR decrease to below 30 mL/min/1.73 m2 mean [SD] age, 73.7 [12.6] years, 1235 discontinued therapy within 6 months after the eGFR decrease and 2674 did not discontinue therapy. A total of 434 patients (35.1%) who discontinued ACE-I or ARB therapy and 786 (29.4%) who did not discontinue therapy died during a median follow-up of 2.9 years (interquartile range, 1.3-5.0 years). In the propensity score–matched sample of 2410 individuals, ACE-I or ARB therapy discontinuation was associated with a higher risk of mortality (hazard ratio [HR], 1.39; 95% CI, 1.20-1.60]) and major cardiovascular events (HR, 1.37; 95% CI, 1.20-1.56), but no statistically significant difference in the risk of ESKD was found (HR, 1.19; 95% CI, 0.86-1.65). The findings suggest that continuing therapy despite deteriorating kidney function is probably justifiable. The original study can be viewed here.