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

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.