{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,10]],"date-time":"2026-08-10T14:45:08Z","timestamp":1786373108884,"version":"build-2736575974"},"reference-count":20,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"5","funder":[{"DOI":"10.13039\/501100016298","name":"ERA-EDTA","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100016298","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/501100016118","name":"KfH Foundation for Preventive Medicine","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100016118","id-type":"DOI","asserted-by":"crossref"}]},{"name":"German Federal Ministry of Education and Research","award":["01EO0802"],"award-info":[{"award-number":["01EO0802"]}]},{"name":"European Reference Network for Rare Kidney Diseases"},{"DOI":"10.13039\/501100000272","name":"National Institute for Health Research","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000272","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["CJASN"],"published-print":{"date-parts":[[2020,5]]},"abstract":"<jats:sec>\n                    <jats:title>Background and objectives<\/jats:title>\n                    <jats:p>Although renin-angiotensin-aldosterone system inhibition (RAASi) is a cornerstone in the treatment of children with CKD, it is sometimes discontinued when kidney function declines. We studied the reasons of RAASi discontinuation and associations between RAASi discontinuation and important risk markers of CKD progression and on eGFR decline in the Cardiovascular Comorbidity in Children with CKD study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design, setting, participants, &amp; measurements<\/jats:title>\n                    <jats:p>\n                      In this study, 69 children with CKD (67% male, mean age 13.7 years, mean eGFR 27 ml\/min per 1.73 m\n                      <jats:sup>2<\/jats:sup>\n                      ) who discontinued RAASi during prospective follow-up were included. Initial change in BP, albuminuria, and potassium after discontinuation were assessed (median time 6 months). Rate of eGFR decline (eGFR slope) during a median of 1.9 years before and 1.2 years after discontinuation were estimated using linear mixed effects modeling.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Physician-reported reasons for RAASi discontinuation were increase in serum creatinine, hyperkalemia, and symptomatic hypotension. After discontinuation of RAASi, BP and albuminuria increased, whereas potassium decreased. eGFR declined more rapidly after discontinuation of RAASi (\u22123.9 ml\/min per 1.73 m\n                      <jats:sup>2<\/jats:sup>\n                      per year; 95% confidence interval, \u22125.1 to \u22122.6) compared with the slope during RAASi treatment (\u22121.5 ml\/min per 1.73 m\n                      <jats:sup>2<\/jats:sup>\n                      per year; 95% confidence interval, \u22122.4 to \u22120.6;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      =0.005). In contrast, no change in eGFR slope was observed in a matched control cohort of patients in whom RAASi was continued.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Discontinuation of RAASi in children with CKD is associated with an acceleration of kidney function decline, even in advanced CKD.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.2215\/cjn.09750819","type":"journal-article","created":{"date-parts":[[2020,4,6]],"date-time":"2020-04-06T16:40:46Z","timestamp":1586191246000},"page":"625-632","source":"Crossref","is-referenced-by-count":24,"title":["Discontinuation of RAAS Inhibition in Children with Advanced CKD"],"prefix":"10.2215","volume":"15","author":[{"given":"Sophie M.","family":"van den Belt","sequence":"first","affiliation":[{"name":"Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hiddo J.L.","family":"Heerspink","sequence":"additional","affiliation":[{"name":"Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marietta","family":"Kirchner","sequence":"additional","affiliation":[{"name":"Institute of Medical Biometry and Informatics, University of Heidelberg, Heidelberg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Valentina","family":"Gracchi","sequence":"additional","affiliation":[{"name":"Department of Pediatric Nephrology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniela","family":"Thurn-Valsassina","sequence":"additional","affiliation":[{"name":"Department of Pediatric Kidney, Liver and Metabolic Diseases, Hannover Medical School, Hannover, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aysun K.","family":"Bayazit","sequence":"additional","affiliation":[{"name":"Department of Pediatric Nephrology, Cukurova University School of Medicine, Adana, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna","family":"Niemirska","sequence":"additional","affiliation":[{"name":"Department of Nephrology, Kidney Transplantation and Arterial Hypertension, The Children\u2019s Memorial Health Institute, Warsaw, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3420-9756","authenticated-orcid":false,"given":"Nur","family":"Canpolat","sequence":"additional","affiliation":[{"name":"Department of Pediatric Nephrology, Istanbul University Cerrahpasa Faculty of Medicine, Istanbul, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ipek","family":"Kaplan Bulut","sequence":"additional","affiliation":[{"name":"Division of Pediatric Nephrology, Department of Pediatrics, Ege University Faculty of Medicine, Izmir, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karolis","family":"Azukaitis","sequence":"additional","affiliation":[{"name":"Clinic of Pediatrics, Faculty of Medicine, Vilnius University, Vilnius, Lithuania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ali","family":"Duzova","sequence":"additional","affiliation":[{"name":"Division of Pediatric Nephrology, Hacettepe University Faculty of Medicine, Ankara, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Justine","family":"Bacchetta","sequence":"additional","affiliation":[{"name":"Centre de R\u00e9f\u00e9rence des Maladies R\u00e9nales Rares, H\u00f4pital Femme M\u00e8re Enfant, Hospices Civils de Lyon, Bron, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rukshana","family":"Shroff","sequence":"additional","affiliation":[{"name":"Department of Pediatric Nephrology, Great Ormond Street Hospital for Children and Institute of Child Health, London, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2091-8890","authenticated-orcid":false,"given":"Dusan","family":"Paripovic","sequence":"additional","affiliation":[{"name":"Department of Pediatric Nephrology, University Children\u2019s Hospital, Belgrade, Serbia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zeynep Birsin","family":"\u00d6z\u00e7akar","sequence":"additional","affiliation":[{"name":"Division of Pediatric Nephrology, Department of Pediatrics, School of Medicine, Ankara University, Ankara, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kibriya","family":"Fidan","sequence":"additional","affiliation":[{"name":"Department of Pediatric Nephrology, Gazi University, Ankara, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hakan","family":"Erdogan","sequence":"additional","affiliation":[{"name":"Department of Nephrology, Bursa Yuksek Ihtisas Teaching and Researching Hospital, Bursa, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jutta","family":"Gellermann","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology, Nephrology, and Metabolic Medicine, Department of Pediatrics, Charit\u00e9 Universit\u00e4tsmedizin Berlin, Berlin, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elke","family":"W\u00fchl","sequence":"additional","affiliation":[{"name":"Division of Pediatric Nephrology, University Hospital Heidelberg, Heidelberg, 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