{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,26]],"date-time":"2026-09-26T12:09:58Z","timestamp":1790424598731,"version":"4.1.0"},"reference-count":96,"publisher":"Oxford University Press (OUP)","issue":"7","license":[{"start":{"date-parts":[[2026,1,22]],"date-time":"2026-01-22T00:00:00Z","timestamp":1769040000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"funder":[{"DOI":"10.13039\/501100004359","name":"Swedish Research Council","doi-asserted-by":"publisher","award":["2023-01807"],"award-info":[{"award-number":["2023-01807"]}],"id":[{"id":"10.13039\/501100004359","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Swedish Heart and Lung Foundation","award":["20250416"],"award-info":[{"award-number":["20250416"]}]},{"name":"Region Stockholm, ALF Medicine","award":["FoUI-986028"],"award-info":[{"award-number":["FoUI-986028"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,6,30]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>Renin\u2013angiotensin system inhibitors (RASis) and sodium\u2013glucose co-transporter 2 inhibitors (SGLT2is) are the cornerstones of management for patients with chronic kidney disease (CKD). The use of these treatments is limited by frequent discontinuations, increasing the risk of death and compromising cardiovascular and renal health. This narrative review explores scenarios that lead to discontinuation: adverse effects (i.e. RASi-related acute kidney injury and hyperkalaemia), progression of CKD, acute illness, surgery and contrast administration. After AKI, we recommend restarting RASis and SGLT2is as soon as kidney function stabilises. For patients with mild-to-moderate hyperkalaemia on RASis, we advocate for thiazide-like diuretics and SGLT2is to avoid RASi discontinuation rather than routine dietary restrictions or potassium binders. We recommend against discontinuing RASis or SGLT2is when glomerular filtration rates decrease gradually. We review the evidence for sick-day rules and find it unconvincing. Withholding RASis before surgery has not been shown to reduce AKI. For low-risk procedures, the decision may be deferred to the anaesthetist. However, in settings where anaesthetists assess patients only shortly before surgery, or in high-risk cases, earlier multidisciplinary input is advised. We recommend stopping SGLT2is 2\u20133\u00a0days before elective procedures that involve fasting or anaesthesia. For the use of intra-arterial contrast, such as with coronary angiography, we do not recommend routinely withholding SGLT2is but we do suggest considering temporarily withholding RASis, especially in patients with advanced CKD or dehydration. We suggest promptly restarting RASis and SGLT2is after events; if both drugs have been withheld for more than a few days, and both are indicated, we suggest a staggered start. By reconciling, reviewing and thoughtfully prescribing medications, drug stewardship can maximize the time spent on these life-prolonging therapies, as long as this aligns with patients\u2019 goals of care.<\/jats:p>","DOI":"10.1093\/ndt\/gfag008","type":"journal-article","created":{"date-parts":[[2026,1,21]],"date-time":"2026-01-21T12:39:51Z","timestamp":1768999191000},"page":"1191-1203","source":"Crossref","is-referenced-by-count":2,"title":["Drug stewardship for RAS inhibitors and SGLT2 inhibitors in chronic kidney disease: stay on, restart"],"prefix":"10.1093","volume":"41","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9977-8637","authenticated-orcid":false,"given":"Pim","family":"Bouwmans","sequence":"first","affiliation":[{"name":"CARIM School for Cardiovascular Diseases, University of Maastricht , Maastricht ,","place":["The Netherlands"]},{"name":"Department of Medical Epidemiology and Biostatistics, Karolinska Institutet , Stockholm ,","place":["Sweden"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4538-5958","authenticated-orcid":false,"given":"Catherine M","family":"Clase","sequence":"additional","affiliation":[{"name":"Department of Medicine, McMaster University , Hamilton, Ontario ,","place":["Canada"]},{"name":"St. Joseph\u2019s Healthcare Hamilton , Hamilton, Ontario ,","place":["Canada"]},{"name":"Department of Health Research Methodology, Evidence and Impact, McMaster University , Hamilton, Ontario ,","place":["Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4763-2024","authenticated-orcid":false,"given":"Juan-Jesus","family":"Carrero","sequence":"additional","affiliation":[{"name":"Department of Medical Epidemiology and Biostatistics, Karolinska Institutet , Stockholm ,","place":["Sweden"]},{"name":"Division of Nephrology, Department of Clinical Sciences, Karolinska Institutet, Danderyd Hospital , Stockholm ,","place":["Sweden"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,1,22]]},"reference":[{"issue":"4S","key":"2026062922471225200_bib1","first-page":"S117","article-title":"KDIGO 2024 clinical practice guideline for the evaluation and management of chronic kidney disease","volume":"105","author":"Kidney Disease: Improving Global Outcomes CKD Work Group","year":"2024","journal-title":"Kidney Int"},{"key":"2026062922471225200_bib2","doi-asserted-by":"publisher","first-page":"e074064","DOI":"10.1136\/bmjopen-2023-074064","article-title":"Are there lost opportunities in chronic kidney disease? 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