Continue ACE inhibitors and ARBs in reduced GFR - it has CV benefits

US: Chronic kidney disease (CKD) independently increases the risk of death and cardiovascular disease (CVD) in the general population. The participants with an estimated glomerular filtration rate (eGFR) decline have a significantly higher risk of all‐cause mortality and cardiovascular events even after adjustment for baseline covariates including the initial eGFR.

The certainty of using drugs that block the renin-angiotensin system in such patients whose estimated GFR is low is been a question. To uncover these researchers from Pennsylvania conducted a retrospective cohort study that was published in JAMA Internal Medicine.

Continuing angiotensin-converting enzyme inhibitors (ACE-Is) and angiotensin II receptor blockers (ARBs) in patients with declining kidney function may deliver cardiovascular benefits without increasing the risk of end-stage kidney disease (ESKD), according to the study.

The retrospective cohort study included 3909 individuals who had initiated ACE-I or ARB therapy and had experienced estimated glomerular filtration rate (eGFR) decrease to <30 mL/min/1.73m2 during therapy. The study was started on 1 January 2004 continued till 25 January 2019. Findings of the study were:

a)Of the 3909 individuals receiving ACE-I or ARB treatment who experienced an eGFR decrease to below 30 mL/min/1.73 m2 female; mean age, 73.7, 1235 discontinued ACE-I or ARB therapy within 6 months after the eGFR decrease and 2674 did not discontinue therapy.

b)A total of 434 patients who discontinued ACE-I or ARB therapy and 786 who did not discontinue therapy died during a median follow-up of 2.9 years.

c)Among the sample, patients who discontinued ACE-I or ARB therapy were associated with a higher risk of mortality (hazard ratio [HR], 1.39;  and MACE (HR, 1.37; ), but no statistically significant difference in the risk of ESKD was found.

The authors concluded the findings suggest continuing ACE-I or ARB therapy in patients with declining kidney function may be associated with the cardiovascular benefit without excessive harm of ESKD.

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doi:10.1001/jamainternmed.2020.0193