Evidence map›Paper›PMID 26429974›Full record

Trial reportNephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association2016

Multicentre randomized controlled trial of angiotensin-converting enzyme inhibitor/angiotensin receptor blocker withdrawal in advanced renal disease: the STOP-ACEi trial.

Sunil Bhandari, Natalie Ives, Elizabeth A Brettell, Marie Valente, Paul Cockwell, Peter S Topham, John G Cleland, Arif Khwaja, Meguid El Nahas

Open access · hybridAbstract readMulticenter StudyRandomized Controlled Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 53 papers, 3 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
53citing papers in PubMed, 3 pooled it
6.6field-weighted citation impact, top 3% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

53 citing papers in PubMed, 3 syntheses or guidelines pooled it, 127 citations in OpenAlex.

  1. Pooled it
  2. Pooled it
  3. Guideline
  4. Trial
  5. Trial
  6. Trial
  7. Review
  8. Biomolecules · 2025
    Review
  9. Review
  10. Future perspective on chronic kidney disease management.Journal of anesthesia and translational medicine · 2025
    Review
  11. Review
  12. Article
  13. Article
  14. Article
  15. Review
  16. Article
  17. Article
  18. Hypertension in chronic kidney disease-treatment standard 2023.Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association · 2023
    Review
  19. Acute Declines in Estimated GFR in Blood Pressure Target Trials and Risk of Adverse Outcomes.American journal of kidney diseases : the official journal of the National Kidney Foundation · 2023
    Observational
  20. Article
4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

9 authors at 7 institutions in 2 countries.

Sunil BhandariDepartment of Renal Medicine, Hull and East Yorkshire Hospitals NHS Trust, Kingston upon Hull, UK Hull York Medical School, East Yorkshire, UK.
Natalie IvesBirmingham Clinical Trials Unit, University of Birmingham, Birmingham, UK.
Elizabeth A BrettellBirmingham Clinical Trials Unit, University of Birmingham, Birmingham, UK.
Marie ValenteBirmingham Clinical Trials Unit, University of Birmingham, Birmingham, UK.
Paul CockwellDepartment of Renal Medicine, Queen Elizabeth Hospital, Birmingham, UK.
Peter S TophamDepartment of Renal Medicine, Leicester General Hospital, Leicester, UK.
John G ClelandNational Heart & Lung Institute, Imperial College London, London, UK.
Arif KhwajaSheffield Kidney Institute, Sheffield, UK.
Meguid El NahasSheffield Kidney Institute, Sheffield, UK.
Cancer Research UK Clinical Trials Unit · GBSheffield Kidney Institute · GBHull and East Yorkshire Hospitals NHS Trust · GBImperial College London · GBLeicester General Hospital · GBQueen Elizabeth Hospital Birmingham · GBUniversity of Birmingham · GB

Funding

Medical Research Council MC_PC_14138
6 · The paper itself

Abstract

backgroundBlood pressure (BP) control and reduction of urinary protein excretion using agents that block the renin-angiotensin aldosterone system are the mainstay of therapy for chronic kidney disease (CKD). Research has confirmed the benefits in mild CKD, but data on angiotensin-converting enzyme inhibitor (ACEi) or angiotensin receptor blocker (ARB) use in advanced CKD are lacking. In the STOP-ACEi trial, we aim to confirm preliminary findings which suggest that withdrawal of ACEi/ARB treatment can stabilize or even improve renal function in patients with advanced progressive CKD.

methodsThe STOP-ACEi trial (trial registration: current controlled trials, ISRCTN62869767) is an investigator-led multicentre open-label, randomized controlled clinical trial of 410 participants with advanced (Stage 4 or 5) progressive CKD receiving ACEi, ARBs or both. Patients will be randomized in a 1:1 ratio to either discontinue ACEi, ARB or combination of both (experimental arm) or continue ACEi, ARB or combination of both (control arm). Patients will be followed up at 3 monthly intervals for 3 years. The primary outcome measure is eGFR at 3 years. Secondary outcome measures include the number of renal events, participant quality of life and physical functioning, hospitalization rates, BP and laboratory measures, including serum cystatin-C. Safety will be assessed to ensure that withdrawal of these treatments does not cause excess harm or increase mortality or cardiovascular events such as heart failure, myocardial infarction or stroke.

resultsThe rationale and trial design are presented here. The results of this trial will show whether discontinuation of ACEi/ARBs can improve or stabilize renal function in patients with advanced progressive CKD. It will show whether this simple intervention can improve laboratory and clinical outcomes, including progression to end-stage renal disease, without causing an increase in cardiovascular events.

Indexed as

Withholding TreatmentAgedAngiotensin-Converting Enzyme InhibitorsAngiotensin Receptor AntagonistsBlood PressureDisease ProgressionFemaleFollow-Up StudiesGlomerular Filtration RateHumansMaleMiddle AgedRenal Insufficiency, ChronicAngiotensin-Converting Enzyme InhibitorsAngiotensin Receptor Antagonistsangiotensin-converting enzyme inhibitor (ACEi)angiotensin II receptor blocker (ARB)chronic kidney diseaseeGFRrandomized controlled trial

Identifiers

PMID26429974
PMCPMC4725389
OpenAlexW2241556252

What OpenQuestion holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.