Stopping renin-angiotensin-aldosterone system inhibitors in kidney disease.

IF 2.4 3区医学 Q3 PERIPHERAL VASCULAR DISEASE

Current Opinion in Nephrology and Hypertension Pub Date : 2026-05-01 Epub Date: 2026-03-13 DOI:10.1097/MNH.0000000000001173

Eva Glenn Lecea, Krystle Frazier, Elaine Ku

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引用次数: 0

Abstract

Purpose: The KDIGO guidelines recommend the use of renin-angiotensin system inhibitors (RASi) in chronic kidney disease (CKD) given their kidney and cardiovascular benefits. Despite this recommendation, real-word data suggest low rates of the use of these medications, and RASi are frequently discontinued. The objective of this review is to summarize the outcomes associated with the discontinuation of RASi in individuals with CKD, hyperkalemia, and acute kidney injury (AKI).

Recent findings: Trial-grade data suggest that there is no benefit to the discontinuation of RASi in patients with low eGFR on kidney or mortality outcomes. Observational and trial-grade data suggests similar outcomes for the continuation of RASi during the perioperative period as compared to discontinuation of RASi. Observational data also suggest that reinitiation of RASi after AKI and hyperkalemia is associated with improved survival and reduces the risk of progression of kidney disease.

Summary: This review highlights outcomes following the discontinuation of RASi, which is generally associated with worse outcomes across the spectrum of CKD, hyperkalemia, and AKI.

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肾病患者停用肾素-血管紧张素-醛固酮系统抑制剂。

目的：鉴于肾素-血管紧张素系统抑制剂（RASi）对肾脏和心血管的益处，KDIGO指南推荐在慢性肾病（CKD）中使用肾素-血管紧张素系统抑制剂（RASi）。尽管有这样的建议，但实际数据表明，这些药物的使用率很低，RASi经常被停用。本综述的目的是总结CKD、高钾血症和急性肾损伤（AKI）患者停用RASi的相关结果。最近的发现：试验级数据表明，对于低eGFR患者，停止RASi对肾脏或死亡率没有好处。观察性和试验级数据表明，在围手术期继续RASi与停止RASi的结果相似。观察数据还表明，AKI和高钾血症后重新开始RASi与改善生存和降低肾脏疾病进展的风险相关。摘要：本综述强调了停用RASi后的结果，RASi通常与CKD、高钾血症和AKI的预后更差相关。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Current Opinion in Nephrology and Hypertension 医学-泌尿学与肾脏学

CiteScore

5.70

自引率

6.20%

发文量

132

审稿时长

6-12 weeks

期刊介绍： A reader-friendly resource, Current Opinion in Nephrology and Hypertension provides an up-to-date account of the most important advances in the field of nephrology and hypertension. Each issue contains either two or three sections delivering a diverse and comprehensive coverage of all the key issues, including pathophysiology of hypertension, circulation and hemodynamics, and clinical nephrology. Current Opinion in Nephrology and Hypertension is an indispensable journal for the busy clinician, researcher or student.