Welcome back to What's it Worth! Join your hosts, Dr. Diana Langworthy and Dr. Garrison Avery (PGY1 Pharmacy Resident), as we discuss the STOP ACEi trial comparing continuation of ACEi/ARB (angiotensin converting enzyme inhibitors/angiotensin receptor blockers) therapy in ESKD vs discontinuation of ACEi/ARB therapy. The authors sought to answer the question - Does discontinuation vs continuation of ACEi/ARB therapy slow the decline in eGFR once someone progresses to Stage 4/5 CKD. Let's get into the weeds of baseline characteristics - follow the episode's breadcrumbs to see if you can spot the key unmeasured confounders in this publication!

Key Points

1. ACEi/ARB therapy has demonstrated proven benefit in slowing the progression of CKD when initiated in Stages 1-3
2. Robust evidence is lacking to guide continuation vs discontinuation of ACEi/ARB therapy once a patient progresses to Stage 4/5 CKD
3. Compound symmetry covariance structures can be a useful statistical tool when the change between study visits in the key measurements is not anticipated to vary greatly (confused? So were we! Listen in for an explanation.)
4. What baseline characteristics might impact the primary outcome that may not have been accounted for? ------> Tune in to find out!

References

1. [EPISODE TRIAL] Bhandari S, Mehta S, Khwaja A, et al. Renin-Angiotensin System Inhibition in Advanced Chronic Kidney Disease. The STOP ACEi Trial. NEJM 2022;387:2021-2032.

2. Kidney Disease: Improving Global Outcomes (KDIGO) CKD Work Group. KDIGO 2024 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease. Kidney Int. 2024 Apr;105(4S):S117-S314. doi: 10.1016/j.kint.2023.10.018. PMID: 38490803.

3. Delgado C, Baweja M, Crews, D, et al. A Unifying Approach for GFR Estimation: Recommendations of the NKF-ASN Task Force on Reassessing the Inclusion of Race in Diagnosing Kidney Disease. JASN 2021;32(1@):2994-3015

4. Xie X, Liu Y, Perkovic V, et al. Renin-Angiotensin System Inhibitors and Kidney and Cardiovascular Outcomes in Patients with CKD: A Bayesian Network Meta-analysis of Randomized Clinical Trials. AJKD 2016;67(5):728-741.

5. DynaMed. Chronic Kidney Disease (CKD) in Adults. EBSCO Information Services. Accessed May 19, 2025. https://www-dynamed-com.ezp3.lib.umn.edu/condition/chronic-kidney-disease-ckd-in-adults-1

Contact Information

Podcast email: [email protected]

Host Information

Dr. Diana R. Langworthy, PharmD, BCPS

Clinical Associate Professor, University of Minnesota College of Pharmacy

Clinical Pharmacist - Inpatient Internal Medicine, M Health Fairview East Bank Hospital

Co-Host Information

Garrison (Griest) Avery, PGY1 Pharmacy Resident

University of Minnesota Medical Center - East Bank