Advanced CKD stage a risk factor for discontinuation of ACE inhibitors, ARBs
Patients at a more advanced stage of chronic kidney disease (CKD) are highly likely to discontinue treatment with commonly used blood pressure (BP)-lowering drugs, such as angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs), a study has found.
Researchers used data from the Geisinger Health System (2004–2015) and identified 54,588 ACE inhibitor/ARB users with a baseline estimated glomerular filtration rate (eGFR) of ≥15 mL/min/1.73 m2. None of the patients had previous diagnosis of end-stage renal disease.
Time to treatment discontinuation, defined as a therapy gap of ≥60 days, was evaluated in relation to CKD stage (ie, G1, G2, G3a, G3b and G4) using Kaplan Meier curves and multivariable Cox proportional hazards models.
Results showed that the risk of discontinuation increased with advancing CKD stage. The hazard ratios (HRs) relative to CKD stage G1 were 1.06 (95 percent CI, 1.03–1.09) with stage G2, 1.24 (1.19–1.30) with stage G3a, 1.49 (1.40–1.59) with stage G3b and 2.31 (2.09–2.57) with stage G4. Estimates were higher when G-stage was treated as time-dependent.
On further analysis, risk of discontinuation was higher in 2008–2011 (HR, 1.16; 1.13–1.19) and 2012–2015 (HR, 1.28; 1.24–1.32) than in 2004–2007. Hospitalizations associated with or not related to acute kidney infection both contributed to increased risk of discontinuation (HR, 17.34; 16.01–18.78 and HR, 4.11; 3.94–4.30, respectively).
Of the 29,029 ACE inhibitor/ARB users who discontinued, 6,187 (21.3 percent) restarted therapy within 6 months of discontinuation.
The findings indicate that more advanced CKD stage is a risk factor for ACE inhibitor/ARB discontinuation, with a trend toward greater discontinuation in more recent years, researchers said.