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Renin-angiotensin system blockade with an angiotensin-converting–enzyme (ACE) inhibitor or an angiotensin-receptor blocker (ARB) benefits patients with mild-to-moderate renal failure (NEJM JW Gen Med Sep 28 2001), but whether these drugs cause reduced glomerular filtration rate (GFR) and hyperkalemia in stage 5 patients who are not receiving dialysis (predialysis patients) is unknown. In this prospective cohort study from Taiwan, researchers identified about 28,000 predialysis patients (mean age, 65; creatinine level, >6 mg/dL; hematocrit, <28%; all receiving erythropoiesis therapy); roughly half of patients received ACE inhibitors or ARBs within 90 days after their serum creatinine levels exceeded 6 mg/dL.
Patients were followed until initi…