PDF(Pubmed)
Abstract：
Discontinuation of renin-angiotensin system (RAS) inhibitors is common in patients with chronic kidney disease (CKD), and the potential danger has been reported in several studies. However, a comprehensive analysis has not been conducted.
This study sought to evaluate the effects of discontinuation of RAS inhibitors in CKD.
Relevant studies up to November 30, 2022, were identified in the PubMed, Embase, Web of Science, and Cochrane Library databases. Efficacy outcomes included the composite of all-cause mortality, cardiovascular events, and end-stage kidney disease (ESKD). Results were combined using a random-effects or fixed-effects model, and sensitivity analysis used the leave-one-out method.
Six observational studies and one randomized clinical trial including 244,979 patients met the inclusion criteria. Pooled data demonstrated that discontinuation of RAS inhibitors was associated with an increased risk of all-cause mortality (HR 1.42, 95% CI 1.23-1.63), cardiovascular event risk (HR 1.25, 95% CI 1.17-1.22), and ESKD (HR 1.23, 95% CI 1.02-1.49). In sensitivity analyses, the risk for ESKD was reduced. Subgroup analysis showed that the risk of mortality was more pronounced in patients with eGFR above 30 mL/min/m2 and in patients with hyperkalemia-related discontinuation. In contrast, patients with eGFR below 30 mL/min/m2 were at great risk of cardiovascular events.
The discontinuation of RAS inhibitors in patients with CKD was associated with a significantly increased risk of all-cause mortality and cardiovascular events. These data suggest that RAS inhibitors should be continued in CKD if the clinical situation allows.
This study sought to evaluate the effects of discontinuation of RAS inhibitors in CKD.
Relevant studies up to November 30, 2022, were identified in the PubMed, Embase, Web of Science, and Cochrane Library databases. Efficacy outcomes included the composite of all-cause mortality, cardiovascular events, and end-stage kidney disease (ESKD). Results were combined using a random-effects or fixed-effects model, and sensitivity analysis used the leave-one-out method.
Six observational studies and one randomized clinical trial including 244,979 patients met the inclusion criteria. Pooled data demonstrated that discontinuation of RAS inhibitors was associated with an increased risk of all-cause mortality (HR 1.42, 95% CI 1.23-1.63), cardiovascular event risk (HR 1.25, 95% CI 1.17-1.22), and ESKD (HR 1.23, 95% CI 1.02-1.49). In sensitivity analyses, the risk for ESKD was reduced. Subgroup analysis showed that the risk of mortality was more pronounced in patients with eGFR above 30 mL/min/m2 and in patients with hyperkalemia-related discontinuation. In contrast, patients with eGFR below 30 mL/min/m2 were at great risk of cardiovascular events.
The discontinuation of RAS inhibitors in patients with CKD was associated with a significantly increased risk of all-cause mortality and cardiovascular events. These data suggest that RAS inhibitors should be continued in CKD if the clinical situation allows.
摘要：
背景：肾素-血管紧张素系统（RAS）抑制剂的停药在慢性肾脏病（CKD）患者中很常见，一些研究已经报道了潜在的危险。然而,尚未进行全面分析。
目的：本研究旨在评估停用RAS抑制剂对CKD的影响。
方法：截至2022年11月30日的相关研究已在PubMed中确定，Embase,WebofScience,和Cochrane图书馆数据库。疗效结果包括全因死亡率，心血管事件,和终末期肾病（ESKD）。使用随机效应或固定效应模型组合结果，敏感性分析采用留一法。
结果：六项观察性研究和一项随机临床试验，包括244,979名患者，符合纳入标准。汇总数据表明，停用RAS抑制剂与全因死亡率风险增加相关(HR1.42,95%CI1.23-1.63)。心血管事件风险（HR1.25，95%CI1.17-1.22），和ESKD（HR1.23，95%CI1.02-1.49）。在敏感性分析中，ESKD的风险降低.亚组分析显示，eGFR高于30mL/min/m2的患者和高钾血症相关停药的患者死亡风险更为明显。相比之下,eGFR低于30mL/min/m2的患者有很高的心血管事件风险.
结论：CKD患者停用RAS抑制剂与全因死亡和心血管事件的风险显著增加相关。这些数据表明，如果临床情况允许，应在CKD中继续使用RAS抑制剂。
目的：本研究旨在评估停用RAS抑制剂对CKD的影响。
方法：截至2022年11月30日的相关研究已在PubMed中确定，Embase,WebofScience,和Cochrane图书馆数据库。疗效结果包括全因死亡率，心血管事件,和终末期肾病（ESKD）。使用随机效应或固定效应模型组合结果，敏感性分析采用留一法。
结果：六项观察性研究和一项随机临床试验，包括244,979名患者，符合纳入标准。汇总数据表明，停用RAS抑制剂与全因死亡率风险增加相关(HR1.42,95%CI1.23-1.63)。心血管事件风险（HR1.25，95%CI1.17-1.22），和ESKD（HR1.23，95%CI1.02-1.49）。在敏感性分析中，ESKD的风险降低.亚组分析显示，eGFR高于30mL/min/m2的患者和高钾血症相关停药的患者死亡风险更为明显。相比之下,eGFR低于30mL/min/m2的患者有很高的心血管事件风险.
结论：CKD患者停用RAS抑制剂与全因死亡和心血管事件的风险显著增加相关。这些数据表明，如果临床情况允许，应在CKD中继续使用RAS抑制剂。
