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Abstract: TH-PO053

Four-Year Report on Renal Outcomes Following Elective Withdrawal of Long-Term RAAS Blockade in a Cohort of Patients With Otherwise Inexplicable New-Onset and Progressive AKI

Session Information

Category: Acute Kidney Injury

  • 102 AKI: Clinical‚ Outcomes‚ and Trials

Author

  • Onuigbo, Macaulay A., University of Vermont College of Medicine, Burlington, Vermont, United States
Background

RAAS blockade is renoprotective for both diabetic and non-diabetic CKD. There have been discordant reports on renal and cardiovascular outcomes following RAAS blockade discontinuation in advanced CKD. To the contrary, a few prospective cohort studies have demonstrated reversal of otherwise inexplicable AKI in patients after discontinuation of RAAS blockade. This is a 4-year report of such a cohort.

Methods

Prospective Cohort Analysis, enrolled between February 2018 – May 2021. Kidney function was monitored after elective withdrawal of long-term RAAS blockade in CKD patients presenting with new-onset otherwise inexplicable progressive AKI as defined by a >25% increase in baseline serum creatinine.

Results

By February 2022, 12 patients had died, and 8 patients were on hemodialysis for ESRD. The remaining 51 patients, with a baseline serum creatinine of 1.30 ± 0.42 (0.66 - 2.70) mg/dL, have been followed up for 706 (40-1478) days. Peak serum creatinine at study entry was 2.17 ± 1.06 (1.1 – 8.3) mg/dL, n=51, P<0.0001, t=6.4872, df=135. Serum creatinine, 48 months later, was 1.58 ± 0.54 (0.84 – 3.3) mg/dL, n=50, p<0.0001, t=5.1805, df=119. Death in 7 of 8 (87.5%) patients were from non-renal causes; most deaths occurred despite improved kidney function.

Conclusion

Our results support the elective withdrawal of long-term RAAS blockade in CKD patients with new-onset progressive yet otherwise inexplicable AKI. Significant sustainable renal salvage is common - Such self-selected patients generally exhibit clearly improved renal outcomes without increased mortality. (Figure). This is testament to the syndrome of late onset renal failure from angiotensin blockade (LORFAB) which we first decsribed in 2005 from the Mayo Clinic Health System in Northwestern Wisconsin.

Serum creatinine trajectory from February 2020 - February 2022 after the elective withdrawal of Losartan 100 mg/d in December 2020