Effect of Discontinuation of Renin Angiotensin-System Inhibitors in Patients With Advanced Chronic Kidney Disease: A Meta-Analysis.

Autor:	Naveed H; Medicine and Surgery, Shifa Tameer-E-Millat University Shifa College of Medicine, Islamabad, PAK., Tirumandyam G; Internal Medicine, Siddhartha Medical College Vijayawada, Tirupathi, IND., Krishna Mohan GV; Internal Medicine, Tirunelveli Medical college, Tirunelveli, IND., Gul S; Internal Medicine, Lady Reading Hospital, Peshawar, PAK., Ali S; Internal Medicine, Khyber Medical College, Peshawar, PAK., Siddiqui A; Pediatrics, Jinnah Sindh Medical University, Karachi, PAK., Suarez ZK; Internal Medicine, Florida Atlantic University Charles E. Schmidt College of Medicine, Boca Raton, USA., Khan A; Critical Care Medicine, United Medical and Dental College, Karachi, PAK.
Jazyk:	angličtina
Zdroj:	Cureus [Cureus] 2023 Apr 19; Vol. 15 (4), pp. e37813. Date of Electronic Publication: 2023 Apr 19 (Print Publication: 2023).
DOI:	10.7759/cureus.37813
Abstrakt:	Renin-angiotensin system inhibitors (RAS) inhibitors include angiotensin receptor blockers (ARBs) and angiotensin-converting enzyme (ACE) inhibitors decrease proteinuria, progression of chronic kidney disease (CKD), and protect against heart failure hospitalizations and cardiovascular events. There is uncertainty about the appropriate time for discontinuing ARB and ACE inhibitor treatment in patients with low estimated glomerular filtration rate (eGFR). In the present meta-analysis, we examined the effect of RAS inhibitor discontinuation on clinical outcomes in patients with advanced CKD compared to the continuation of RAS inhibitors. Two authors conducted electronic database searches in PubMed, the Cochrane Library, and Excerpta Medica Database (EMBASE) for relevant studies published from the inception of the databases to March 15th, 2023, using the following combination of keywords or key terms: "Renin-angiotensin-system," "angiotensin-converting-enzyme inhibitors", "Angiotensin receptor blockers," and "advanced chronic kidney disease." Primary outcomes assessed in this meta-analysis included cardiovascular events. Secondary outcomes assessed included all-cause mortality and end-stage kidney disease (ESKD). A total of four studies were included in this meta-analysis. The pooled analysis showed that cardiovascular events were significantly higher in patients in the discontinuation group compared to the continuation group (HR: 1.38, 95% CI: 1.21-1.58), ESKD was also significantly higher in the discontinuation group (HR: 1.29, 95% CI: 1.18-1.41). No significant differences were reported between the two groups in all-cause mortality. In conclusion, our meta-analysis provides evidence that continuation of RAS inhibitors could be beneficial in patients with advanced CKD, as it is associated with less risk of cardiovascular events and ESKD. Competing Interests: The authors have declared that no competing interests exist. (Copyright © 2023, Naveed et al.)
Databáze:	MEDLINE
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