Impact of Loop Diuretics on Long-Term Kidney Outcome: A Post-Hoc Analysis of the STOP-ACEi Trial

This podcast discusses a post hoc analysis of the STOP-ACEi trial, examining whether baseline loop diuretic use modifies the effect of Renin–Angiotensin System Inhibitors in advanced CKD. Among patients not receiving loop diuretics, stopping Renin-angiotensin system inhibitors was associated with lower eGFR at three years and a faster decline in kidney function. In contrast, among patients taking loop diuretics, the decline in eGFR was slower and withdrawal of RAS inhibitors had little effect on eGFR decline. Rates of ESKD and KRT were similar between groups, although mortality appeared higher in patients receiving loop diuretics. Overall, the findings suggest that discontinuing RAS inhibitors may be more harmful in advanced CKD patients who are not taking loop diuretics.