Do you take a blood pressure medication known as a renin-angiotensin system (RAS) inhibitor? Common ones prescribed are angiotensin-converting-enzyme (ACE) inhibitors such as lisinopril and benazeparil, and angiotensin-receptor blockers (ARBs) such as losartan and valsartan. 

While there’s substantial evidence that RAS inhibitors slow disease progression in people with mild to moderate chronic kidney disease (CKD), research findings on the safety and efficacy of RAS inhibitors in patients with advanced CKD have been inconsistent. Learn what one study discovered when testing advanced CKD patients with RAS inhibitors.* 

What they did

The researchers recruited 411 patients who had stage 4 or 5 CKD, with an estimated glomerular filtration rate (eGFR) of less than 30 (less than 30% remaining kidney function). Patients who were either receiving dialysis or who had received a kidney transplant were not eligible. 

All participants had been taking RAS inhibitors for at least six months at the time of the study. Of the 411 participants:

• 206 discontinued RAS inhibitors, and
• 205 continued receiving RAS inhibitors. 

After three years, researchers followed up with patients and analyzed changes in their eGFR and other lab work. 

What they found

At the end of the three years:

• 62% of patients in the discontinuation group v. 56% in the continuation group had either:
  • progressed to end-stage kidney disease (ESKD), or 
  • received renal replacement therapy (such as dialysis). 

Between the groups, new cases of hospitalization, adverse cardiovascular (heart-related) episodes, and death were similar. 

What it means

The study’s findings do not support the continuation of RAS inhibitors in late stage CKD. “Although the use of RAS inhibitors has been found to slow the decline in eGFR in patients with mild or moderate chronic kidney disease,” the researchers wrote, “our findings are consistent with the possibility that these drugs may not be as helpful in patients with advanced and progressive chronic kidney disease.”

*McNulty, R. (2022, December 16). Study Finds RAS Inhibition Has Little Effect on Outcomes in Advanced Chronic Kidney Disease. Pharmacy Times. https://www.pharmacytimes.com/view/study-finds-ras-inhibition-has-little-effect-on-outcomes-in-advanced-chronic-kidney-disease