6/29/23, 11:56 PM STOP-ACEi Pathway Feedback Search Clinical Topics Home Studies STOP ACEi STOP ACEi Disease Chronic kidney disease Trial question What is the effect of discontinuation of renin-angiotensin system inhibitors in patients with advanced CKD? Study design Multi-center Open label RCT Population Characteristics of study participants 32.0% female N = 411 68.0% male 411 patients (130 female, 281 male) Inclusion criteria: adult patients with advanced and progressive CKD Key exclusion criteria: uncontrolled hypertension; history of myocardial infarction or stroke within the previous 3 months Interventions N=206 renin-angiotensin system inhibitor discontinuation (use of any guideline-recommended antihypertensive agent other than renin-angiotensin system inhibitors) N=205 renin-angiotensin system inhibitor continuation (renin-angiotensin system inhibitor with/without any other guideline-recommended antihypertensive agent) https://web.pathway.md/studies/recv0MfYu0pPyKuD6 1/2 6/29/23, 11:57 PM STOP-ACEi Pathway Primary outcome Estimated glomerular filtration rate at 3 years 13.3 13.3 12.6 10.0 6.7 3.3 No significant difference 0.0 Renin-angiotensin system inhibitor discontinuation Renin-angiotensin system inhibitor continuation No significant difference in eGFR at 3 years (12.6 vs. 13.3; AD -0.7, 95% CI -2.5 to 1) Secondary outcomes No significant difference in end-stage kidney disease or renal-replacement therapy (62% vs. 56%; HR 1.28, 95% CI 0.99 to 1.65) No significant difference in the percentage of patients experiencing > 50% decline in eGFR or initiation of renal-replacement therapy (68% vs. 63%; RR 1.07, 95% CI 0.94 to 1.22) No significant difference in death (10% vs. 11%; HR 0.85, 95% CI 0.46 to 1.57) Safety outcomes No significant difference in serious adverse events. Conclusion In adult patients with advanced and progressive CKD, renin-angiotensin system inhibitor discontinuation was not superior to renin-angiotensin system inhibitor continuation with respect to eGFR at 3 years. Reference Sunil Bhandari, Samir Mehta, Arif Khwaja et al. Renin-Angiotensin System Inhibition in Advanced Chronic Kidney Disease. N Engl J Med. 2022 Dec 1;387(22):2021-2032. Open reference URL https://web.pathway.md/studies/recv0MfYu0pPyKuD6 2/2