Evaluation of the stopping angiotensin converting enzyme inhibitor compared to angiotensin receptor blocker (STOP ACEi trial) in advanced and progressive chronic kidney disease.
Evaluation of the stopping angiotensin converting enzyme inhibitor compared to angiotensin receptor blocker (STOP ACEi trial) in advanced and progressive chronic kidney disease.
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评估停止血管紧张素转换酶抑制剂与血管紧张素受体阻滞剂（STOP ACEi 试验）在晚期和进展性慢性肾脏病中的比较。
DOI：
10.1016/j.kint.2023.09.012
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发表时间：
2024
影响因子：
19.6
通讯作者：
Bhandari S
中科院分区：
文献类型：
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作者：
Bhandari S
在STOP-ACEi试验中，无论是否停用肾素-血管紧张素系统抑制剂（RASi），结局均相似。我们现在研究是否撤销血管紧张素转换酶抑制剂（ACEi）或血管紧张素受体阻滞剂（ARB）的影响不同。在这项开放标签试验中，估计肾小球滤过率（eGFR）低于30 ml/min/1.73 m2和进行性慢性肾病（CKD）的患者被随机分配停止或继续RASi。主要结局是3年时的eGFR。还评估了肾衰竭、eGFR下降超过50%或肾脏替代治疗（KRT）的复合终点。在随机化的患者中，基线时99例患者停止使用ACEi，123例患者继续使用ACEi，104例患者停止使用ARB，77例患者继续使用ARB。3年时，无论患者是否退出ACEi或ARB，eGFR均相似。65%的停用ACEi患者和54%的继续使用ACEi患者发生肾衰竭或开始KRT（停用风险比为1.52; 95%置信区间为1.07 - 2.16），60%的ARB患者发生肾衰竭或开始KRT（停用风险比为1.23; 0.83 - 1.81），与随机分组无关。肾功能衰竭/KRT启动伴eGFR下降超过50%的发生率为71%的停用ACEi患者和59%的继续使用ACEi患者（停用时的相对风险为1.19; 95% CI，1.00 - 1.41），以及65%的停用ARB患者和69%的继续使用ARB患者（停用时的相对风险为0.96; 0.79 - 1.16）。因此，停用ACEi或ARB均未减缓eGFR的下降速率。尽管停用ACEi对肾脏结局的不利影响似乎比停用ARB更大，但该试验的设计和把握度均不足以显示药物之间的差异。
In the STOP-ACEi trial, the outcome was similar whether or not renin–angiotensin system inhibitors (RASi) were discontinued. We now investigate whether the effect of withdrawing angiotensin converting enzyme inhibitors (ACEi) or angiotensin-receptor blockers (ARBs) differed. In this open label trial patients with estimated glomerular filtration rates (eGFR) under 30ml/min per 1.73 m2and progressive chronic kidney disease (CKD) were randomized to stop or continue RASi. The primary outcome was eGFR at three years. The composite of kidney failure, over 50% fall in eGFR, or kidney replacement therapy (KRT) was also assessed. Of patients randomized, 99 stopped and 123 patients continued ACEi while 104 stopped and 77 continued ARB at baseline. At three years, the eGFR was similar whether or not patients were withdrawn from ACEi or from ARB. Kidney failure or initiation of KRT occurred in 65% of those stopping and 54% continuing ACEi (hazard ratio if stopped, 1.52; 95% Confidence Interval, 1.07 to 2.16) and in 60% on an ARB regardless of randomized group (hazard ratio if stopped, 1.23; 0.83 to 1.81). Kidney failure/Initiation of KRT with over 50% decline in eGFR occurred in 71% of those stopping and 59% continuing ACEi (relative risk if stopped, 1.19; 95% CI, 1.00 to 1.41) and in 65% stopping and 69% continuing ARB (relative risk if stopped, 0.96; 0.79 to 1.16). Thus, neither discontinuing ACEi nor ARB slowed the rate of decline in eGFR. Although discontinuation of ACEi appeared to have more unfavorable effects on kidney outcomes than stopping ARB, the trial was neither designed nor powered to show differences between agents.
DOI：
10.1053/j.ajkd.2013.03.018
发表时间：
2013-08
期刊：
American journal of kidney diseases : the official journal of the National Kidney Foundation
影响因子：
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作者：
Taler SJ;Agarwal R;Bakris GL;Flynn JT;Nilsson PM;Rahman M;Sanders PW;Textor SC;Weir MR;Townsend RR
通讯作者：
Townsend RR
影响因子：
8.3
作者：
Siragy, HM;de Gasparo, M;Carey, RM
通讯作者：
Carey, RM
晚期 CKD 中的肾素-血管紧张素系统抑制。
DOI：
10.1056/nejmc2302340
发表时间：
2023
期刊：
The New England journal of medicine
影响因子：
--
作者：
J. Sealey;Jon D. Blumenfeld
通讯作者：
Jon D. Blumenfeld