{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,7,30]],"date-time":"2025-07-30T16:12:33Z","timestamp":1753891953408,"version":"3.41.2"},"reference-count":9,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2023,5,4]],"date-time":"2023-05-04T00:00:00Z","timestamp":1683158400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Pediatr."],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>It is not known whether withdrawal of angiotensin-converting enzyme inhibitors (ACEIs) in children with advanced chronic kidney disease (CKD) is beneficial similar to adults. We report a case series of children with advanced CKD whose ACEIs were stopped.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>In the last 5 years, we stopped ACEIs in seven consecutive children on ACEI therapy with rapidly declining CKD stage 4\u20135. The median age was 12.5 years (range 6.8\u201317.6); the median estimated glomerular filtration rate (eGFR) at stopping ACEIs was 12.5\u2005ml\/min\/1.73\u2005m<jats:sup>2<\/jats:sup> (range 8.8\u201319.9).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Six to twelve months after stopping ACEIs, the eGFR increased in five children (71%). The median absolute increase of eGFR was 5.0\u2005ml\/min\/1.73\u2005m<jats:sup>2<\/jats:sup> (range \u22122.3 to +20.0) and relative increase of eGFR was 30% (range \u221234 to +99). The median follow-up after stopping ACEIs was 2.7 (range 0.5\u20135.0) years, either until the start of dialysis (<jats:italic>n<\/jats:italic>\u2009=\u20095) or until the last follow-up without dialysis (<jats:italic>n<\/jats:italic>\u2009=\u20092).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>This case series showed that withdrawal of ACEIs in children with CKD stage 4\u20135 and rapidly declining kidney function may lead to an increase in eGFR.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fped.2023.1172567","type":"journal-article","created":{"date-parts":[[2023,5,4]],"date-time":"2023-05-04T04:24:46Z","timestamp":1683174286000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Case report: Withdrawal of angiotensin-converting enzyme inhibitors in children with advanced chronic kidney disease and rapidly declining kidney function"],"prefix":"10.3389","volume":"11","author":[{"given":"Tom\u00e1\u0161","family":"Seeman","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ji\u0159\u00ed","family":"Du\u0161ek","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2023,5,4]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"625","DOI":"10.2215\/CJN.09750819","article-title":"Discontinuation of RAAS inhibition in children with advanced CKD","volume":"15","author":"van den Belt","year":"2020","journal-title":"Clin J Am Soc Nephrol"},{"key":"B2","doi-asserted-by":"publisher","first-page":"3977","DOI":"10.1093\/ndt\/gfp511","article-title":"The impact of stopping inhibitors of the renin-angiotensin system in patients with advanced chronic kidney disease","volume":"25","author":"Ahmed","year":"2010","journal-title":"Nephrol Dial Transplant"},{"key":"B3","doi-asserted-by":"publisher","first-page":"1726","DOI":"10.1038\/ki.1995.238","article-title":"Increased glomerular filtration rate after withdrawal of long-term antihypertensive treatment in diabetic nephropathy","volume":"47","author":"Hansen","year":"1995","journal-title":"Kidney Int"},{"key":"B4","doi-asserted-by":"publisher","first-page":"233","DOI":"10.1007\/s11255-007-9299-2","article-title":"Late-onset renal failure from angiotensin blockade (LORFFAB) in 100 CKD patients","volume":"40","author":"Onuigbo","year":"2008","journal-title":"Int Urol Nephrol"},{"key":"B5","doi-asserted-by":"publisher","first-page":"629","DOI":"10.1681\/ASN.2008030287","article-title":"New equations to estimate GFR in children with CKD","volume":"20","author":"Schwartz","year":"2009","journal-title":"J Am Soc Nephrol"},{"key":"B6","doi-asserted-by":"publisher","first-page":"347","DOI":"10.1001\/jamainternmed.2013.12700","article-title":"Renoprotective effect of renin-angiotensin-aldosterone system blockade in patients with predialysis advanced chronic kidney disease, hypertension, and anemia","volume":"174","author":"Hsu","year":"2014","journal-title":"JAMA Intern Med"},{"key":"B7","doi-asserted-by":"publisher","first-page":"1751","DOI":"10.1007\/s00467-020-04788-w","article-title":"When should we start and stop ACEi\/ARB in paediatric chronic kidney disease?","volume":"36","author":"Chan","year":"2021","journal-title":"Pediatr Nephrol"},{"key":"B8","doi-asserted-by":"publisher","first-page":"643","DOI":"10.1007\/s00467-016-3512-4","article-title":"Renin-angiotensin II-aldosterone system blockers and time to renal replacement therapy in children with CKD","volume":"32","author":"Abraham","year":"2017","journal-title":"Pediatr Nephrol"},{"key":"B9","doi-asserted-by":"publisher","first-page":"255","DOI":"10.1093\/ndt\/gfv346","article-title":"Multicentre randomized controlled trial of angiotensin-converting enzyme inhibitor\/angiotensin receptor blocker withdrawal in advanced renal disease: the STOP-ACEi trial","volume":"31","author":"Bhandari","year":"2016","journal-title":"Nephrol Dial Transplant"}],"container-title":["Frontiers in Pediatrics"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fped.2023.1172567\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,5,4]],"date-time":"2023-05-04T04:24:48Z","timestamp":1683174288000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fped.2023.1172567\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,5,4]]},"references-count":9,"alternative-id":["10.3389\/fped.2023.1172567"],"URL":"https:\/\/doi.org\/10.3389\/fped.2023.1172567","relation":{},"ISSN":["2296-2360"],"issn-type":[{"type":"electronic","value":"2296-2360"}],"subject":[],"published":{"date-parts":[[2023,5,4]]},"article-number":"1172567"}}