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As CKD Progresses, ACE-I/ARB Discontinuation Rates Increase


November 07, 2019

More than half of patients with chronic kidney disease (CKD) stopped taking angiotensin converting enzyme inhibitors and angiotensin receptor blockers (ACE-I/ARB) within 5 years of initiating them, according to a study published in Mayo Clinic Proceedings. 

“In a real-world cohort, discontinuation of ACE-I/ARB was common, particularly in patients with lower estimated glomerular filtration rate (eGFR),” researchers wrote. 

The study looked at a cohort of nearly 54,000 patients at Geisinger Health System between 2004 and 2015 who had CKD and used ACE-I/ARB. At baseline, all participants had an eGFR ≥15 mL/min/1.73 m2 and did not have end-stage renal disease. 

In addition to identifying a high ACE-I/ARB discontinuation rate overall, researchers found the risk of ACE-I/ARB discontinuation increased with advancement of CKD stage.

“For example,” they wrote, “patients who initiated ACE-I/ARB with CKD stage G4 (eGFR: 15-29 mL/min/1.73 m2) were 2.09-fold (95% CI, 1.87-2.34) more likely to discontinue therapy than those with eGFR ≥ 90 mL/min/1.73 m2.” 

Other strong risk factors for ACE-I/ARB discontinuation were hyperkalemia, hypotension, low bicarbonate level, and hospitalization related to acute kidney injury, researchers reported. While loop diuretic use was associated with a higher discontinuation risk, thiazide diuretic use was linked with lower risk. 

“Additional studies are needed to evaluate the risk-benefit balance of discontinuing ACE-I/ARB in the setting of CKD progression,” researchers advised. 

Jolynn Tumolo

Reference

Qiao Y, Shin JI, Sang Y, et al. Discontinuation of angiotensin converting enzyme inhibitors and angiotensin receptor blockers in chronic kidney disease [published online ahead of print October 13, 2019]. Mayo Clin Proc. 2019;94(11):2220-2229. doi: 10.1016/j.mayocp.2019.05.031

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