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Abstract: PUB057

The Impact of Elective Withdrawal of Long-Term Concurrent RAAS Blockade in CKD Patients Presenting with Progressive AKI: A Prospective 40-Months’ Single-Unit Analysis

Session Information

Category: Acute Kidney Injury

  • 102 AKI: Clinical, Outcomes, and Trials

Author

  • Onuigbo, Macaulay A., University of Vermont College of Medicine, Burlington, Vermont, United States
Background

There is consensus that RAAS blockade is renoprotective for both diabetic and non-diabetic proteinuric CKD. Nevertheless, there remains considerable debate and controversy regarding renal and cardiovascular (CV) outcomes with discontinuation of concurrent RAAS blockade in advanced CKD. Recent studies demonstrated discordant renal and CV outcomes.

Methods

In a Nephrology Office at the University of Vermont Medical Center, in Burlington, VT, USA, over 40 months, February 2018 – May 2021, concurrent RAAS blockade was electively discontinued in all patients who presented with progressive and >25% increase in baseline serum creatinine. Kidney function of this cohort was followed prospectively.

Results

71 patients, 69 Caucasians, 1 African American and 1 Hispanic, 42:29 (M:F), mean age 69.4 (37-95) years were treated. Medical co-morbidities included diabetes mellitus (37) and hypertension (66). They were mostly asymptomatic. Lisinopril was commonest agent in 40 (56%) patients. Mean duration of RAAS blockade before discontinuation was 2057 (112-4043) days. Baseline creatinine was 1.38 ± 0.49 (0.66 - 2.7) mg/dL, n=70. Peak creatinine was 2.31 ± 1.09 (1.1 – 8.3) mg/dL, n=67, P<0.0001, t=6.4872, df=135. Nadir creatinine after drug discontinuation was 1.49 ± 0.45 (0.84 – 3.3) mg/dL, n=54, p<0.0001, t=5.1805, df=119. There were 5 (7%) deaths from nonrenal causes. Hyperkalemia in 34 (48%) and hyperphosphatemia in 13 (18%) resolved with improved kidney function.

Conclusion

The elective withdrawal of concurrent RAAS blockade in CKD patients who present with progressive worsening AKI generally demonstrate clearly improved renal outcomes. We posit that in selected CKD patients with progressive AKI such as in our study, RAAS blockade discontinuation indeed is the correct next step in their management for both improved renal and CV outcomes.

Kidney function trajectory after stopping Olmesartan