The impact of stopping inhibitors of the renin-angiotensin system in patients with advanced chronic kidney disease

Abstract

Discontinuation of ACEi/ARB has undoubtedly delayed the onset of RRT in the majority of those studied. This observation may justify a rethink of our approach to the inhibition of the RAAS in patients with advanced CKD who are nearing the start of RRT.

Late onset renal failure from angiotensin blockade (LORFFAB) and the syndrome of rapid onset endstage renal disease (SORO-ESRD) revisited – Two case reports from Mayo Clinic Health System, Northwestern Wisconsin, USA; a review paper

“…Quite often, the interval between the precipitating AKI event and the need for RRT is less than 2 weeks, and commonly is only in days following cardiothoracic procedures (7)(8)(9)(10). Following our reports on the syndrome of LORFFAB and having raised concerns regarding the unrecognized potential nephrotoxicity associated with angiotensin blockade, similar experiences have been observed in a few other centers around the world, including the work of El Nahas and his group from the Sheffield Kidney Institute, Sheffield, in the United Kingdom, implicating angiotensin blockade in the causation of clinically significant and sometimes unrecognized renal failure (11)(12)(13). In this article, we describe two representative case reports, one each of both syndromes, and discuss the implications of LORFFAB and SORO-ESRD in current nephrology practice paradigms.…”

“…Since our first report of the syndrome of LORFFAB in 2005, over the last ten or more years, we have variously described the features of this syndrome in various journal publications, book chapters and editorial pieces as well as in professional academic intellectual forums and presentations (1)(2)(3)(4)(5)(6). It was indeed our work at the Mayo Clinic Health System in Northwestern Wisconsin that spurred the work of El Nahas and his group from the Sheffield Kidney Institute, Sheffield in the United Kingdom who concluded in 2010 that discontinuation of ACEI/ARB had undoubtedly delayed the onset of RRT in the majority of those studied and that this observation might justify a rethink of our approach to the inhibition of the renin-angiotensin-aldosterone system (RAAS) in patients with advanced CKD who are nearing the start of RRT (11,12). Some other investigators around the world have shown similar reports raising concerns about the potential nephrotoxicity of angiotensin blockade especially in the elderly (>65-year old) with more advanced CKD (13)(14)(15).…”

The effects of quercetin on oxidative stress and fibrosis markers in chronic kidney disease rat model

“…Kim and Vaziri demonstrated that the longer the CKD occured, the worse the increase of serum creatinine. 22 Ahmed et al 23 demonstrated that the administration of angiotensin converting enzyme inhibitor (ACEI) in the early phase of CKD increased serum creatinine mildly to moderately in patients with deterioration of renal function due to the loss of renal mass which lead to perturbation in the autoregulatory mechanism of the remaining renal vasculature. Subsequently, renal function would either improve or resolve with long-term blood pressure control, reflecting restoration of renal autoregulation towards normal function.…”

Блокатори Ренін-Ангіотензинової Системи, Швидкість Клубочкової Фільтрації Й Артеріальний Тиск

“…-при снижении СКФ менее 30 мл/мин/м 2 (или 15 мл/мин/м 2 [13]), вероятно, следует отказаться от назначения блокаторов РАС ввиду негативного вли-яния на рСКФ. В этом случае применяемая в нефро-логической практике формула БРИМОНЕЛ + (аль-дактон/эплеренон и торасемид/ксипамид) -БР(А) И(АПФ)МО(ксонидин)НЕ(биволол)Л(еркани-дипин) заменяется на МОНЕЛ + урапидил/минок-сидил [12].…”