{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,12]],"date-time":"2026-01-12T22:43:10Z","timestamp":1768257790487,"version":"3.49.0"},"reference-count":18,"publisher":"Springer Science and Business Media LLC","issue":"5","license":[{"start":{"date-parts":[[2024,3,4]],"date-time":"2024-03-04T00:00:00Z","timestamp":1709510400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2024,3,4]],"date-time":"2024-03-04T00:00:00Z","timestamp":1709510400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Hypertens Res"],"published-print":{"date-parts":[[2024,5]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>It is controversial whether renin-angiotensin system inhibitors (RASIs) should be stopped in patients with advanced chronic kidney disease (CKD). Recently, it was reported that stopping RASIs in advanced CKD was associated with increased mortality and cardiovascular (CV) events; however, it remains unclear whether stopping RASIs before dialysis initiation affects clinical outcomes after dialysis, which this study aimed to evaluate. In this multicenter prospective cohort study in Japan, we included 717 patients (mean age, 67 years; 68% male) who had a nephrology care duration \u226590 days, initiated hemodialysis, and used RASIs 3 months before hemodialysis initiation. The multivariable adjusted Cox models were used to compare mortality and CV event risk between 650 (91%) patients who continued RASIs until hemodialysis initiation and 67 (9.3%) patients who stopped RASIs. During a median follow-up period of 3.5 years, 170 (24%) patients died and 228 (32%) experienced CV events. Compared with continuing RASIs, stopping RASIs was unassociated with mortality (adjusted hazard ratio [aHR]: 0.82; 95% confidence interval [CI]: 0.50\u20131.34) but was associated with higher CV events (aHR: 1.59; 95% CI: 1.06\u20132.38). Subgroup analyses showed that the risk of stopping RASIs for CV events was particularly high in patients aged &lt;75 years, with a significant interaction between stopping RASIs and age. This study revealed that patients who stopped RASIs immediately before dialysis initiation were associated with subsequent higher CV events. Active screening for CV disease may be especially beneficial for these patients.<\/jats:p>","DOI":"10.1038\/s41440-024-01616-8","type":"journal-article","created":{"date-parts":[[2024,3,4]],"date-time":"2024-03-04T10:02:37Z","timestamp":1709546557000},"page":"1372-1379","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Association between stopping renin-angiotensin system inhibitors immediately before hemodialysis initiation and subsequent cardiovascular events"],"prefix":"10.1038","volume":"47","author":[{"given":"Yoshihiro","family":"Nakamura","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Daijo","family":"Inaguma","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Takahiro","family":"Imaizumi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shimon","family":"Kurasawa","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Manabu","family":"Hishida","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Masaki","family":"Okazaki","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yuki","family":"Fujishima","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nobuhiro","family":"Nishibori","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Katsuhiko","family":"Suzuki","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yuki","family":"Takeda","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shoichi","family":"Maruyama","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2024,3,4]]},"reference":[{"key":"1616_CR1","doi-asserted-by":"publisher","first-page":"572","DOI":"10.1038\/ki.2011.223","volume":"80","author":"CA Herzog","year":"2011","unstructured":"Herzog CA, Asinger RW, Berger AK, Charytan DM, D\u00edez J, Hart RG, et al. 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Hypertens Res. 2022;45:1072\u20135.","journal-title":"Hypertens Res"},{"key":"1616_CR6","doi-asserted-by":"publisher","first-page":"1235","DOI":"10.1038\/s41440-019-0284-9","volume":"42","author":"S Umemura","year":"2019","unstructured":"Umemura S, Arima H, Arima S, Asayama K, Dohi Y, Hirooka Y, et al. The Japanese Society of Hypertension Guidelines for the Management of Hypertension (JSH 2019). Hypertens Res. 2019;42:1235\u2013481.","journal-title":"Hypertens Res"},{"key":"1616_CR7","doi-asserted-by":"publisher","first-page":"3977","DOI":"10.1093\/ndt\/gfp511","volume":"25","author":"AK Ahmed","year":"2010","unstructured":"Ahmed AK, Kamath NS, El Kossi M, El Nahas AM. The impact of stopping inhibitors of the renin-angiotensin system in patients with advanced chronic kidney disease. 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T.I. has received grants and honoraria from Kyowa Kirin; consulting fees from GlaxoSmithKline. S.M. has received grants and\/or research funding from Chugai, Mitsubishi Tanabe, Ono, and ROHTO; honoraria from Alexion, Astellas, AstraZeneca, Bayer, Mitsubishi Tanabe, Kyowa Kirin, and Novartis.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"This study was approved by the Institutional Review Board of Nagoya Daini Red Cross Hospital and each participating facility in the AICOPP group (the approval number: 20110823-3) and was conducted in accordance with the Ethical guidelines for Clinical Research by the Japanese Ministry of Health, Labor, and Welfare (created July 30, 2003; full revision December 28, 2004; full revision July 31, 2008) and the Helsinki Declaration (revised 2013). The subjects received oral and written explanations of the purpose of the study and provided their written consent.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics statement"}}]}}