Discontinuation of Renin-Angiotensin System Inhibitors and Risk of End-Stage Renal Disease and Cardiovascular Outcomes Among Patients With Type 2 Diabetes and Chronic Kidney Disease: A Nationwide Taiwanese Cohort Study.
Journal
Pharmacoepidemiology and drug safety
Journal Volume
35
Journal Issue
2
Start Page
Article number e70323
ISSN
1099-1557
Date Issued
2026-02
Author(s)
Abstract
Purpose: This nationwide cohort study examined the effects of discontinuation versus continuation of renin–angiotensin system inhibitors (RASis) on major renal and cardiovascular outcomes after the estimated glomerular filtration rate (eGFR) decreased to below 45 mL/min/1.73 m2 in patients with type 2 diabetes and treated with RASis. Methods: Using linked Taiwanese databases with claims and clinical data, we identified patients with type 2 diabetes who used RASis during 2016–2020, and either discontinued or continued RASis within 180 days when their eGFR fell below 45 mL/min/1.73 m2. The outcomes of interest included end-stage renal disease (ESRD), myocardial infarction, stroke, heart failure, and all-cause mortality. We estimated the hazard ratios (HRs) and 95% confidence intervals (CIs) for RASi discontinuation versus RASi continuation using on-treatment and intention-to-treat analyses and inverse probability weighting to adjust for baseline and time-varying covariates. Results: We identified 251 853 eligible patients, of whom 37 108 (15%) discontinued RASis and 214 745 (85%) continued RASis. The on-treatment HR associated with RASi discontinuation was 2.52 (95% CI, 2.33–2.73) for ESRD, 1.18 (1.08–1.30) for myocardial infarction, 1.28 (1.19–1.37) for stroke, 1.18 (1.13–1.24) for heart failure, and 1.77 (1.70–1.84) for all-cause mortality. Results from the intention-to-treat analysis were similar, albeit more conservative. Findings remained consistent across eGFR strata (≥ 30 to < 45 and < 30 mL/min/1.73 m2), urine albumin-creatinine ratio categories (≥ 300 and < 300 mg/g), and patient subgroups with various baseline characteristics. Conclusion: Our results support continuing RASi treatment even when the eGFR declines to below 45 mL/min/1.73 m2 based on potential renal, cardiovascular, and survival benefits.
Subjects
chronic kidney disease
discontinuation
end‐stage renal disease
heart failure
inverse probability weighting
mortality
myocardial infarction
renin–angiotensin system inhibitors
stroke
type 2 diabetes
Type
journal article