It is controversial whether renin-angiotensin system inhibitors (RASIs) should be stopped in patients with advanced chronic kidney disease (CKD). Recently, it was reported that stopping RASIs in advanced CKD was associated with increased mortality and cardiovascular (CV) events; however, it remains unclear whether stopping RASIs before dialysis initiation affects clinical outcomes after dialysis, which this study aimed to evaluate. In this multicenter prospective cohort study in Japan, we included 717 patients (mean age, 67 years; 68% male) who had a nephrology care duration ≥90 days, initiated hemodialysis, and used RASIs 3 months before hemodialysis initiation. The multivariable adjusted Cox models were used to compare mortality and CV event risk between 650 (91%) patients who continued RASIs until hemodialysis initiation and 67 (9.3%) patients who stopped RASIs. During a median follow-up period of 3.5 years, 170 (24%) patients died and 228 (32%) experienced CV events. Compared with continuing RASIs, stopping RASIs was unassociated with mortality (adjusted hazard ratio [aHR]: 0.82; 95% confidence interval [CI]: 0.50–1.34) but was associated with higher CV events (aHR: 1.59; 95% CI: 1.06–2.38). Subgroup analyses showed that the risk of stopping RASIs for CV events was particularly high in patients aged <75 years, with a significant interaction between stopping RASIs and age. This study revealed that patients who stopped RASIs immediately before dialysis initiation were associated with subsequent higher CV events. Active screening for CV disease may be especially beneficial for these patients.

对于晚期慢性肾脏病（CKD）患者是否应停用肾素-血管紧张素系统抑制剂（RASIs）尚存在争议。最近，有报道称，晚期 CKD 患者停止 RASIs 与死亡率和心血管 (CV) 事件增加相关；然而，目前尚不清楚在透析开始前停止 RASIs 是否会影响透析后的临床结果，本研究旨在评估这一点。在日本的这项多中心前瞻性队列研究中，我们纳入了 717 名患者（平均年龄 67 岁；68% 男性），他们的肾脏科护理时间≥90 天，开始血液透析，并在开始血液透析前 3 个月使用 RASIs。多变量调整 Cox 模型用于比较 650 名 (91%) 继续 RASIs 直至开始血液透析的患者和 67 名 (9.3%) 停止 RASIs 的患者之间的死亡率和心血管事件风险。在中位随访 3.5 年期间，170 名患者 (24%) 死亡，228 名患者 (32%) 经历了心血管事件。与持续 RASIs 相比，停止 RASIs 与死亡率无关（调整后风险比 [aHR]：0.82；95% 置信区间 [CI]：0.50–1.34），但与较高的心血管事件相关（aHR：1.59；95% CI：1.06） –2.38）。亚组分析显示，年龄 <75 岁的患者因心血管事件而停止 RASIs 的风险特别高，停止 RASIs 与年龄之间存在显着的交互作用。这项研究表明，在透析开始前立即停止 RASIs 的患者与随后较高的 CV 事件相关。主动筛查心血管疾病可能对这些患者特别有益。