HDCN Abstract:  ASN Annual Meeting -- San Francisco  

Onuigbo MA, Onuigbo NT

Renal Failure from RAAS Blockade? - Sustained Improved eGFR Following Withdrawal of RAAS Blockade in 100 CKD Patients Presenting with Accelerated Renal Failure.

ASN Annual Meeting -- San Francisco
J Am Soc Nephrol (Nov) 18:629A 2007

OBJECTIVE: Despite proven cardio/renoprotection from RAAS blockade (AB), concerns remain about iatrogenic renal failure from AB. We prospectively followed eGFR following withdrawal of AB in selected CKD patients with accelerated renal failure.

PATIENTS AND METHODS: From September 2002- February 2005, we enrolled CKD patients on AB presenting with >25% increase in baseline serum creatinine (SCr). AB was discontinued; eGFR was monitored.

RESULTS: 100 Caucasians - 52:48 M:F, age 71.5 years. Sixteen progressed to ESRD; 7 died. In 74 patients, eGFR increased from 23.9 +/- 9.0 to 39.2 +/- 15.4 ml/min/1.73 m2 BSA (p<0.001), 26.5 months after stopping AB. Late-onset renal failure from AB (LORFFAB) occurred in 5 patients with normal renal arteries without precipitating factors - eGFR increased from 17.0 +/- 7.4 to 24.6 +/- 9.5 ml/min/1.73 m2 BSA, (p=0.008), 29.6 months after stopping AB. In 26 patients with RAS, 5 progressed to ESRD of whom 4 died. The ESRD group had higher baseline SCr - 2.1 +/- 0.6 vs 1.5 +/- 0.4 mg/dL, p=0.013. In 19 patients with RAS, eGFR increased from 27.8 +/- 9.5 to 39.7 +/- 14.9 ml/min/1.73 m2 BSA (p=0.001), 26.4 months after stopping AB. Seven patients had CIN; 2 who progressed to ESRD were older, 81.5 vs 68.6 years, (p=0.017). In 5, eGFR increased from 16.6 +/- 6.8 to 41.0 +/- 27.1 ml/min/1.73 m2 BSA (p NS), 29.4 months after stopping AB.

CONCLUSION: Accelerated renal failure in CKD patients on AB is prospectively reported. Older age >70 years, RAS, CIN, and low baseline eGFR are risk factors for ESRD. Stopping AB, in such selected CKD patients often results in sustained improved eGFR and should be considered a viable therapeutic option.



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