{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,11]],"date-time":"2026-08-11T20:29:43Z","timestamp":1786480183578,"version":"build-2736575974"},"reference-count":19,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"4","license":[{"start":{"date-parts":[[2026,1,20]],"date-time":"2026-01-20T00:00:00Z","timestamp":1768867200000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"funder":[{"name":"NIHR Bristol Biomedical Research Center","award":["NIHR-HTA 11\/30\/07. STOP ACEi"],"award-info":[{"award-number":["NIHR-HTA 11\/30\/07. STOP ACEi"]}]},{"name":"NIHR Bristol Biomedical Research Center","award":["NIHR-HTA 11\/30\/07. STOP ACEi"],"award-info":[{"award-number":["NIHR-HTA 11\/30\/07. STOP ACEi"]}]}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":["Kidney360"],"published-print":{"date-parts":[[2026,4]]},"abstract":"\n Key Points<\/jats:title>\n \n \n \n Renin-angiotensin system inhibitors have less effect on decline in eGFR and no greater effect on delaying ESKD\/KRT in patients receiving loop diuretics compared with those who do.<\/jats:p>\n <\/jats:list-item>\n \n Although loop diuretic use was not associated with higher rates of ESKD\/KRT, it might be associated with a higher mortality.<\/jats:p>\n <\/jats:list-item>\n \n The decline in eGFR was slower in those taking loop diuretics.<\/jats:p>\n <\/jats:list-item>\n <\/jats:list>\n <\/jats:p>\n <\/jats:sec>\n \n Background<\/jats:title>\n \n In the STOP-Angiotensin-Converting Enzyme Inhibitor trial, patients with advanced CKD were randomized to continue or stop renin-angiotensin system inhibitors (RASi) and showed no difference in kidney outcomes. This\n post hoc<\/jats:italic>\n analysis investigates interactions with loop diuretic use.\n <\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n \n Patients with eGFR <30 ml\/min per 1.73 m\n 2<\/jats:sup>\n and progressive CKD were randomized to stop or continue RASi. Primary outcome was eGFR over 3 years using repeated-measures, mixed-effects linear regression, random-slope models. Cox models were used to calculate hazard ratios for time-to-event outcomes, including ESKD and KRT.\n <\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n At baseline, eGFR, arterial pressure, and proteinuria were similar for 133 patients taking loop diuretics and 278 who were not. Those receiving loop diuretics at randomization, least-squares mean (\u00b1SE) eGFR at 3 years was 12.3 (\u00b11.1) for those stopping compared with 10.1 (\u00b11.2) for those continuing RASi, trend favoring stopping RASi (+2.2; 95% confidence interval [CI], \u20130.9 to 5.4), but eGFR slope over 3 years was similar (\u22127.2 versus \u22127.7 ml\/min per 1.73 m\n 2<\/jats:sup>\n ). Those not receiving loop diuretics, eGFR at 3-years was 8.8 (\u00b10.8) and 11.6 (\u00b10.8; discontinue and continue RASi groups), a difference favoring continuing RASi (\u20132.8; 95% CI, \u20134.9 to \u22120.8), and a steeper eGFR slope for those discontinuing RASi (\u22129.9 versus \u22127.6 ml\/min per 1.73 m\n 2<\/jats:sup>\n ). The interaction between loop diuretic use and the effect of RASi on eGFR at 3 years and the three-way interaction between diuretic subgroup, effect of RASi, and time were both statistically significant (\n P<\/jats:italic>\n = 0.01 and\n P<\/jats:italic>\n = 0.04, respectively). Of patients taking loop diuretics, 73 (55%) developed ESKD\/KRT and 23 (17%) died. Of patients not taking loop diuretics, 170 (61%) developed ESKD\/KRT and 19 (7%) died.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n Withdrawal of RASi was associated with a steeper decline in eGFR over 3 years in those not receiving loop diuretics, but this was not observed in those who were taking loop diuretics. Patients receiving loop diuretics had a high mortality. These data support the need for randomized trials investigating the efficacy and safety of loop diuretics in patients with advanced CKD.<\/jats:p>\n <\/jats:sec>","DOI":"10.34067\/kid.0000001080","type":"journal-article","created":{"date-parts":[[2026,1,20]],"date-time":"2026-01-20T17:00:50Z","timestamp":1768928450000},"page":"777-785","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":0,"title":["Impact of Loop Diuretics on Long-Term Kidney Outcome"],"prefix":"10.34067","volume":"7","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0996-9622","authenticated-orcid":false,"given":"Sunil","family":"Bhandari","sequence":"first","affiliation":[{"name":"Department of Renal Medicine, Hull University Teaching Hospitals NHS Trust, Hull York Medical School, Kingston Upon Hull, United 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