Should ACE-Is and ARBs be discontinued in CKD 5 because they compromise residual kidney function?
It has long been recognized that commencing ACE-Is and ARBs can lead to an acute reduction in GFR that may be reversed if the dose is reduced or if the drug is discontinued. This phenomenon has been observed in the context of RCTs such as the RENAAL trial. However, any benefits of combined blockade of the RAAS for clinically important renal outcomes remain unproven, and the safety issues should be taken into account prior to using this therapeutic approach.