Discontinuation of RAAS Inhibition in Children with Advanced CKD

Sophie M. van den Belt*, Hiddo J. L. Heerspink, Marietta Kirchner, Valentina Gracchi, Daniela Thurn-Valsassina, Aysun K. Bayazit, Anna Niemirska, Nur Canpolat, Ipek Kaplan Bulut, Karolis Azukaitis, Ali Duzova, Justine Bacchetta, Rukshana Shroff, Dusan Paripovic, Zeynep Birsin Ozcakar, Kibriya Fidan, Hakan Erdogan, Jutta Gellermann, Elke Wuehl, Dick de ZeeuwAnette Melk, Uwe Querfeld, Franz Schaefer

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

8 Citations (Scopus)

Abstract

Background and objectives Although renin-angiotensin-aldosterone system inhibition (RAASi) is a cornerstone in the treatment of children with CKD, it is sometimes discontinued when kidney function declines. We studied the reasons of RAASi discontinuation and associations between RAASi discontinuation and important risk markers of CKD progression and on eGFR decline in the Cardiovascular Comorbidity in Children with CKD study.

Design, setting, participants,& measurements In this study, 69 children with CKD(67% male, mean age 13.7 years, mean eGFR 27 ml/min per 1.73m(2)) who discontinued RAASi during prospective follow-up were included. Initial change in BP, albuminuria, and potassium after discontinuation were assessed (median time 6 months). Rate of eGFR decline (eGFR slope) during a median of 1.9 years before and 1.2 years after discontinuation were estimated using linear mixed effects modeling.

Results Physician-reported reasons for RAASi discontinuation were increase in serum creatinine, hyperkalemia, and symptomatic hypotension. After discontinuation of RAASi, BP and albuminuria increased, whereas potassium decreased. eGFR declined more rapidly after discontinuation of RAASi (23.9 ml/min per 1.73m2 per year; 95% confidence interval, 25.1 to 22.6) compared with the slope during RAASi treatment (21.5 ml/min per 1.73 m(2) per year; 95% confidence interval, 22.4 to 20.6; P=0.005). In contrast, no change in eGFR slope was observed in a matched control cohort of patients in whom RAASi was continued.

Conclusions Discontinuation of RAASi in children with CKD is associated with an acceleration of kidney function decline, even in advanced CKD.

Original languageEnglish
Pages (from-to)625-632
Number of pages8
JournalClinical Journal of the American Society of Nephrology
Volume15
Issue number5
DOIs
Publication statusPublished - 7-May-2020

Keywords

  • RAAS inhibition
  • pediatric nephrology
  • chronic renal disease
  • Hyperkalemia
  • albuminuria
  • Renin-Angiotensin System
  • creatinine
  • blood pressure
  • Potassium
  • Prospective Studies
  • Follow-Up Studies
  • glomerular filtration rate
  • Renal Insufficiency
  • Chronic
  • Cohort Studies
  • Blood Pressure Determination
  • hypotension
  • Comorbidity
  • Acceleration
  • TYPE-2 DIABETIC-NEPHROPATHY
  • RENIN-ANGIOTENSIN SYSTEM
  • RENAL OUTCOMES
  • KIDNEY-DISEASE
  • BLOOD-PRESSURE
  • PROTEINURIA
  • TELMISARTAN
  • WITHDRAWAL
  • REDUCTION
  • LOSARTAN

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