Use of ACEIs and ARBs in advanced chronic kidney disease does not worsen, and may improve, renal outcomes

Question clinique

In patients with advanced chronic kidney disease (stage IV or V), does the continued use of renin-angiotensin system inhibitors have a worsening effect on renal function?


Although some experts have recommended the discontinuation of RAS inhibitors in patients with advanced chronic kidney disease (GFR < 30 mL/min/1.73 m2), this study supports their continuation with no evidence of harm and a possible reduction in the need for renal replacement therapy. 1b

Plan de l'etude: Randomized controlled trial (nonblinded)

Financement: Government

Cadre: Outpatient (any)


Mark H. Ebell, MD, MS
University of Georgia
Athens, GA

Discutez de ce POEM


Pieter Richard Verbeek

Use of ACEIs and ARBs in advanced chronic kidney disease doe

So the reviewer points out that there was no sig. difference in eGFR, hospitalizations, cardiovascular events, or deaths but curiously concludes that even though the same was found with the requirement for renal replacement therapy (i.e. not significantly different) the observed difference was nevertheless clinically significant. I would say this represents a bit of over-exuberant cherry picking. One might be cautiously optimistic at this point but not time to jump in with both feet yet. Would like to see further study on this issue.


ACEI & ARB and renal function

This study provide valuable new information that will impact routine clinical practice in a positive manner.


ace and arb rx in CKD

does not worsen and may improve ckd


Impact assessment

Very good