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

A recent study in NDT in Dec 2010 discussed this very issue. Inhibition of the renin-angiotensin-aldosterone system (RAAS) has shown to slow chronic kidney disease (CKD) progression. This is most notable at the earlier stages of diabetic and proteinuric nephropathies. What happens and is it beneficial in Stage IV-V and does it prevent faster progression to ESRD. In this study, 12 months after discontinuation of ACEi/ARB eGFR increased significantly to 26.6 ± 2.2 ml/min/ 1.73 m(2) (p = 0.0001). 61.5% of patients had more than a 25% increase in eGFR, whilst 36.5% had an increase exceeding 50%. Overall proteinuria was not affected.
Should we be rethinking this approach? Residual Renal function again comes to mind and how important that might be more than inhibition of RAS.
What do others think?
Ref:
http://www.ncbi.nlm.nih.gov/pubmed/19820248