Should We Continue ACE Inhibitors and ARBs in Patients with Advanced Kidney Disease?

Angiotensin-converting–enzyme (ACE) inhibitors and angiotensin-receptor blockers (ARBs) can slow progression of mild-to-moderate chronic kidney disease (CKD). But are they beneficial, harmful, or neutral in patients with advanced CKD? To address this question, U.K. researchers identified 411 adults with estimated glomerular filtration rate (GFR) <30 mL/minute/1.73 m² who had been receiving ACE inhibitors or ARBs and randomized them to discontinue or continue these drugs. At baseline, median serum creatinine was 3.4 mg/dL and median GFR was 18 mL/minute. Patients on dialysis were excluded.

At median follow-up of 3 years, these outcomes were noted:

• Mean GFR was about 13 mL/minute in both groups; however, the proportion of patients progressing t…