WASHINGTON—Patients with non-dialysis-dependent chronic kidney disease who discontinue angiotensin-converting enzyme inhibitor (ACEi) or angiotensin receptor blocker (ARB) therapy are at increased risk for death and progression to dialysis initiation, according to study findings presented at the American Society of Nephrology’s 2019 Kidney Week conference.
For the study, investigators at Baylor College of Medicine in Houston led by Carl P. Walther, MD, identified 238,615 Veterans Affairs patients (96.7% male and had a mean age of 71 years) with NDD-CKD who met their study entry criteria, which included an estimated glomerular filtration rate less than 60 mL/min/1.73 m2 for more than 90 days. Patients entered the cohort at the time they started ACEi or ARB therapy. The investigators identified discontinuation of treatment based on pharmacy fill data. Dr Walther and his colleagues examined 3 durations of discontinuation: less than 90 days, 90 to 180 days, and more than 180 days.
Of the 238,615 patients, 69,544 died and 6100 initiated dialysis. After adjusting for demographic and clinical factors, discontinuation for less than 90 days, 90 to 180 days, and more than 180 days was significantly associated with 2.7-, 2.6- and 2.1-fold increased risks for death, respectively, and 2.4-, 2.9-, and 2.5-fold increased risks for dialysis initiation, respectively, compared with no discontinuation, Dr Walther’s team reported.
Walther CP, Richardson P, Winkelmayer WC, et al. ACEi/ARB discontinuation and adverse outcomes in CKD. Presented during a November 7, 2019 oral session at the American Society of Nephrology’s 2019 Kidney Week conference in Washington, DC. Abstract TH-OR057.