{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,10]],"date-time":"2026-10-10T16:07:13Z","timestamp":1791648433702,"version":"4.3.4"},"reference-count":43,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"2","funder":[{"DOI":"10.13039\/501100004359","name":"Swedish Research Council","doi-asserted-by":"publisher","award":["2019-01059"],"award-info":[{"award-number":["2019-01059"]}],"id":[{"id":"10.13039\/501100004359","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100003793","name":"Swedish Heart and Lung Foundation","doi-asserted-by":"publisher","award":["20190587"],"award-info":[{"award-number":["20190587"]}],"id":[{"id":"10.13039\/501100003793","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100013341","name":"Westman Charitable Foundation","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100013341","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Karolinska University Hospital"},{"DOI":"10.13039\/501100003514","name":"Stockholm City Council","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100003514","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":["JASN"],"published-print":{"date-parts":[[2021,2]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>It is unknown whether stopping renin-angiotensin system (RAS) inhibitor therapy in patients with advanced CKD affects outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      We studied patients referred to nephrologist care, listed on the Swedish Renal Registry during 2007\u20132017, who developed advanced CKD (eGFR&lt;30 ml\/min per 1.73 m\n                      <jats:sup>2<\/jats:sup>\n                      ) while on RAS inhibitor therapy. Using target trial emulation techniques on the basis of cloning, censoring, and weighting, we compared the risks of stopping within 6 months and remaining off treatment versus continuing RAS inhibitor therapy. These included risks of subsequent 5-year all-cause mortality, major adverse cardiovascular events, and initiation of kidney replacement therapy (KRT).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Of 10,254 prevalent RAS inhibitor users (median age 72 years, 36% female) with new-onset eGFR &lt;30 ml\/min per 1.73 m\n                      <jats:sup>2<\/jats:sup>\n                      , 1553 (15%) stopped RAS inhibitor therapy within 6 months. Median eGFR was 23 ml\/min per 1.73 m\n                      <jats:sup>2<\/jats:sup>\n                      . Compared with continuing RAS inhibition, stopping this therapy was associated with a higher absolute 5-year risk of death (40.9% versus 54.5%) and major adverse cardiovascular events (47.6% versus 59.5%), but with a lower risk of KRT (36.1% versus 27.9%); these corresponded to absolute risk differences of 13.6 events per 100 patients, 11.9 events per 100 patients, and \u22128.3 events per 100 patients, respectively. Results were consistent whether patients stopped RAS inhibition at higher or lower eGFR, across prespecified subgroups, after adjustment and stratification for albuminuria and potassium, and when modeling RAS inhibition as a time-dependent exposure using a marginal structural model.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In this nationwide observational study of people with advanced CKD, stopping RAS inhibition was associated with higher absolute risks of mortality and major adverse cardiovascular events, but also with a lower absolute risk of initiating KRT.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1681\/asn.2020050682","type":"journal-article","created":{"date-parts":[[2020,12,28]],"date-time":"2020-12-28T13:30:13Z","timestamp":1609162213000},"page":"424-435","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":178,"title":["Stopping Renin-Angiotensin System Inhibitors in Patients with Advanced CKD and Risk of Adverse Outcomes: A Nationwide Study"],"prefix":"10.1681","volume":"32","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9698-6825","authenticated-orcid":false,"given":"Edouard L.","family":"Fu","sequence":"first","affiliation":[{"name":"Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marie","family":"Evans","sequence":"additional","affiliation":[{"name":"Department of Clinical Science, Intervention and Technology, Karolinska Institute, Stockholm, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Catherine M.","family":"Clase","sequence":"additional","affiliation":[{"name":"Department of Medicine and Health Research Methods, Evidence and Impact, McMaster University, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8848-9493","authenticated-orcid":false,"given":"Laurie A.","family":"Tomlinson","sequence":"additional","affiliation":[{"name":"Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Merel","family":"van Diepen","sequence":"additional","affiliation":[{"name":"Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2433-2494","authenticated-orcid":false,"given":"Friedo W.","family":"Dekker","sequence":"additional","affiliation":[{"name":"Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juan J.","family":"Carrero","sequence":"additional","affiliation":[{"name":"Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2020,12,28]]},"reference":[{"key":"B1-20240826","doi-asserted-by":"crossref","first-page":"1857","DOI":"10.1016\/S0140-6736(96)11445-8","article-title":"Randomised placebo-controlled trial of effect of ramipril on decline in glomerular filtration rate and risk of terminal renal failure in proteinuric, non-diabetic nephropathy","volume":"349","year":"1997","journal-title":"Lancet"},{"key":"B2-20240826","doi-asserted-by":"crossref","first-page":"861","DOI":"10.1056\/NEJMoa011161","article-title":"Effects of losartan on renal and cardiovascular outcomes in patients with type 2 diabetes and nephropathy","volume":"345","author":"Brenner","year":"2001","journal-title":"N Engl J Med"},{"key":"B3-20240826","doi-asserted-by":"crossref","first-page":"73","DOI":"10.7326\/0003-4819-135-2-200107170-00007","article-title":"Angiotensin-converting enzyme inhibitors and progression of nondiabetic renal disease. 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