What is the current evidence regarding discontinuing ACE-Is and ARBs in patients with advanced CKD to preserve residual kidney function?
The current evidence does not support the discontinuing ACE-Is and ARBs in patients with advanced CKD in an effort to preserve residual kidney function, although hyperkalemia or hypotension may be a specific reason for discontinuation in some patients. A post hoc analysis of this study found an initial fall in GFR to predict better long-term outcomes. Such acute changes in GFR are likely to reflect the hemodynamic changes that accompany initiation of RAAS blockade. An RCT that specifically randomized patients with advanced CKD to benzapril or placebo did not support these observations, and reported that patients receiving benzapril had a lower risk of doubling of SCr, kidney failure, or death compared with those receiving placebo. Additionally, a small study of 60 peritoneal dialysis patients showed better preservation of residual kidney function among patients randomized to ramipril as compared to no treatment.