Pharmacoepidemiology and drug safety · 2026
Discontinuation of Renin-Angiotensin System Inhibitors and Risk of End-Stage Renal Disease and Cardiovascular Outcomes Among Patients With Type 2 Diabetes and Chronic Kidney Disease: A Nationwide Taiwanese Cohort Study.
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Dong Yaa-Hui, Chang Chia-Hsuin, Wu Li-Chiu, Toh Sengwee
Аннотация
PURPOSE: This nationwide cohort study examined the effects of discontinuation versus continuation of renin-angiotensin system inhibitors (RASis) on major renal and cardiovascular outcomes after the estimated glomerular filtration rate (eGFR) decreased to below 45 mL/min/1.73 m2 in patients with type 2 diabetes and treated with RASis.
METHODS: Using linked Taiwanese databases with claims and clinical data, we identified patients with type 2 diabetes who used RASis during 2016-2020, and either discontinued or continued RASis within 180 days when their eGFR fell below 45 mL/min/1.73 m2. The outcomes of interest included end-stage renal disease (ESRD), myocardial infarction, stroke, heart failure, and all-cause mortality. We estimated the hazard ratios (HRs) and 95% confidence intervals (CIs) for RASi discontinuation versus RASi continuation using on-treatment and intention-to-treat analyses and inverse probability weighting to adjust for baseline and time-varying covariates.
RESULTS: We identified 251 853 eligible patients, of whom 37 108 (15%) discontinued RASis and 214 745 (85%) continued RASis. The on-treatment HR associated with RASi discontinuation was 2.52 (95% CI, 2.33-2.73) for ESRD, 1.18 (1.08-1.30) for myocardial infarction, 1.28 (1.19-1.37) for stroke, 1.18 (1.13-1.24) for heart failure, and 1.77 (1.70-1.84) for all-cause mortality. Results from the intention-to-treat analysis were similar, albeit more conservative. Findings remained consistent across eGFR strata (≥ 30 to < 45 and < 30 mL/min/1.73 m2), urine albumin-creatinine ratio categories (≥ 300 and < 300 mg/g), and patient subgroups with various baseline characteristics.
CONCLUSION: Our results support continuing RASi treatment even when the eGFR declines to below 45 mL/min/1.73 m2 based on potential renal, cardiovascular, and survival benefits.
METHODS: Using linked Taiwanese databases with claims and clinical data, we identified patients with type 2 diabetes who used RASis during 2016-2020, and either discontinued or continued RASis within 180 days when their eGFR fell below 45 mL/min/1.73 m2. The outcomes of interest included end-stage renal disease (ESRD), myocardial infarction, stroke, heart failure, and all-cause mortality. We estimated the hazard ratios (HRs) and 95% confidence intervals (CIs) for RASi discontinuation versus RASi continuation using on-treatment and intention-to-treat analyses and inverse probability weighting to adjust for baseline and time-varying covariates.
RESULTS: We identified 251 853 eligible patients, of whom 37 108 (15%) discontinued RASis and 214 745 (85%) continued RASis. The on-treatment HR associated with RASi discontinuation was 2.52 (95% CI, 2.33-2.73) for ESRD, 1.18 (1.08-1.30) for myocardial infarction, 1.28 (1.19-1.37) for stroke, 1.18 (1.13-1.24) for heart failure, and 1.77 (1.70-1.84) for all-cause mortality. Results from the intention-to-treat analysis were similar, albeit more conservative. Findings remained consistent across eGFR strata (≥ 30 to < 45 and < 30 mL/min/1.73 m2), urine albumin-creatinine ratio categories (≥ 300 and < 300 mg/g), and patient subgroups with various baseline characteristics.
CONCLUSION: Our results support continuing RASi treatment even when the eGFR declines to below 45 mL/min/1.73 m2 based on potential renal, cardiovascular, and survival benefits.
Предметные рубрики MeSH
HumansFemaleDiabetes Mellitus, Type 2MaleKidney Failure, ChronicTaiwanAgedMiddle AgedCohort StudiesGlomerular Filtration RateCardiovascular DiseasesRenal Insufficiency, ChronicAngiotensin-Converting Enzyme InhibitorsRenin-Angiotensin SystemRisk FactorsAngiotensin Receptor AntagonistsTreatment InterruptionDatabases, Factual