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Article summary:
1. The Renin–Angiotensin System (RAS) inhibitors, including ACE inhibitors and ARBs, can slow the progression of mild or moderate chronic kidney disease.
2. This study aimed to assess whether discontinuing RAS inhibitors in patients with advanced chronic kidney disease would increase or stabilize the estimated glomerular filtration rate (eGFR).
3. The results showed that discontinuing RAS inhibitors was not associated with a significant difference in the long-term rate of decrease in eGFR compared to continuing therapy.
Article analysis:
The article is generally reliable and trustworthy, as it is published in a reputable journal and provides detailed information on the methods used for the study, such as its multicenter open-label design, randomization of participants into two groups (discontinuation vs continuation of RAS inhibitors), primary outcome measure (eGFR at 3 years), secondary outcomes measures (development of end-stage kidney disease, hospitalization, blood pressure, exercise capacity and quality of life), and prespecified subgroups according to age, eGFR, type of diabetes, mean arterial pressure and proteinuria. The authors also provide a clear explanation of their results and conclusions.
However, there are some potential biases that should be noted. Firstly, the study was funded by two government organizations which may have influenced the results. Secondly, although the authors mention that they excluded eGFR values obtained after initiation of renal-replacement therapy from their analysis, they do not provide any further details on how this was done or what criteria were used for exclusion. Thirdly, although the authors mention that adverse events were similar between both groups with respect to cardiovascular events and deaths, they do not provide any further details on other types of adverse events that may have occurred during the trial period. Finally, although the authors mention that no heterogeneity in outcome according to prespecified subgroups was observed in their analysis, they do not provide any further details on how this was assessed or what specific subgroups were included in their analysis.