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Kidney Week

Abstract: FR-OR115

RAAS Inhibitors and Risk of ESRD and Mortality in Advanced CKD

Session Information

Category: CKD (Non-Dialysis)

  • 1902 CKD (Non-Dialysis): Clinical, Outcomes, and Trials


  • Arora, Nayan, UW, Seattle, Washington, United States
  • Katz, Ronit, UW, Seattle, Washington, United States
  • Bansal, Nisha, UW, Seattle, Washington, United States

Inhibition of the renin-angiotensin-aldosterone system (RAASi) is standard of care in early to moderate CKD. However their use in advanced CKD is controversial due to lack of data on safety and efficacy. We described the use of RAASi among a large advanced CKD cohort and tested the association of differing patterns of RAASi use with clinical outcomes.


We identified participants of the Chronic Renal Insufficiency Cohort (CRIC) study with eGFR <30 mL/min/1.73m2. A physician reviewed all available longitudinal study visit data and classified participants into groups based on RAASi use (defined as use of ACEi or ARBs): (1) no RAASi use; (2) continuous RAASi use; and (3) treated dynamically with periods off and on RAASi during advanced CKD. Cox models were used to test the association of patterns of RAASi use with risk of ESRD and mortality, adjusting for potential confounders.


Of the 761 participants with advanced CKD (mean eGFR 25 ml/min/1.73 m2), 167 (22%) did not take a RAASi throughout the study period, 319 (42%) took a RAASi continuously and 275 (36%) had a dynamic approach to RAASi use. Dynamic treatment with RAASi was associated with the lowest cumulative rates of ESRD and mortality (Figure). In multivariable models, a dynamic treatment strategy was associated with a 46% lower risk of ESRD (HR 0.54, 95% CI: 0.41,0.71) and a 23% lower risk of death (HR 0.77, 95% CI: 0.46, 0.97) compared with no RAASi use. The association of continuous ACEi/ARB use with clinical outcomes did not significantly differ from no RAASi use.


In a large, multi-center cohort of participants with advanced CKD, there was heterogeneity in patterns of use of RAASi. A dynamic, personalized approach to RAASi use in advanced CKD may be linked with lower risk of ESRD and mortality

KM curves for ESRD and death by patterns of RAASi use in advanced CKD