Several factors occur to me... 1) Much of the reason Pts are DC their RAASi is fear of hyperkalemia. Given the modern K-binders such as patiromer, that risk is significantly reduced and would allow the PTs to continue on the RAASi. 2) Concomitant use of SGLT2 was not looked at. Given that the indication of use in now includes eGFRs down in that range, it would be interesting to see the effect on M&M with concomitant use (although Im not sure if any IRB would approve the study). 3) Given the trend for delay to HD in Pts on RAASi, and the relative negligible cost of RASSi there is likely a meaningful reduction in over all health care system costs with continued RASSi use.
Several factors occur to me... 1) Much of the reason Pts are DC their RAASi is fear of hyperkalemia. Given the modern K-binders such as patiromer, that risk is significantly reduced and would allow the PTs to continue on the RAASi. 2) Concomitant use of SGLT2 was not looked at. Given that the indication of use in now includes eGFRs down in that range, it would be interesting to see the effect on M&M with concomitant use (although Im not sure if any IRB would approve the study). 3) Given the trend for delay to HD in Pts on RAASi, and the relative negligible cost of RASSi there is likely a meaningful reduction in over all health care system costs with continued RASSi use.