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Observational Study
. 2025 Sep;20(6):1787-1801.
doi: 10.1007/s11739-025-04026-x. Epub 2025 Jul 15.

Prescription of ACE-Is/ARBs in patients with cardio-renal disease: a multicenter retrospective cohort study from the REPOSI registry

Paolo Lido  1   2 , Silvia Cantiero  3 , Antonio Galluccio  4 , Annalisa Noce  5 , Luca Di Lullo  6 , Roberto Bei  7 , Ferdinando Iellamo  7 , Pier Mannuccio Mannucci  8 , Alessandro Nobili  3 , Mauro Tettamanti  3 ; REPOSI investigators
Collaborators, Affiliations
Observational Study

Prescription of ACE-Is/ARBs in patients with cardio-renal disease: a multicenter retrospective cohort study from the REPOSI registry

Paolo Lido et al. Intern Emerg Med. 2025 Sep.

Abstract

Cardio-renal disease is a common clinical condition leading to increased morbidity and mortality. Angiotensin-converting enzyme inhibitors (ACE-Is) and angiotensin II receptor blockers (ARBs) are the cornerstone of treatment of chronic cardio-renal disease. Using data from the REPOSI register, we performed a multicenter, observational, retrospective study to determine which factors are associated with the non-prescription or discontinuation of ACE-Is/ARBS in a cohort of 889 cardio-renal patients hospitalized in 109 Italian internal medicine and geriatric wards. Only 55% of the patients with cardio-renal disease of the investigated cohort were on treatment with ACE-Is or ARBs at admission. The primary end point was ACE-Is/ARBs use at discharge. Patients with lower probability of receiving ACE-Is/ARBs at discharge were older and hospitalized for longer periods. Furthermore, patients with advanced chronic kidney disease (advanced CKD: eGFR ≤ 29 mL/min/1.73m²) had a much lower (54%) probability of being discharged or continuing ACE-Is/ARBs treatment than those with eGFR ≥ 60 mL/min/1.73m². A more prominent lower probability was found comparing advanced CKD patients with G3 stage CKD patients (eGFR: 59-30 mL/min/1.73m²) in multivariate analyses (OR and 95%CI: 0.37, 0.24-0.57. multivariate p-value < 0.001). The probability of stopping treatment in patients already on treatment with ACE-Is/ARBs at hospital admission (secondary end point) almost reached a threefold increase (OR and 95%CI: 2.82, 1.69-4.71. multivariate p-value < 0.001) when the advanced CKD group was compared with G3 CKD patients. The data of our study are not in line with the recently published updated KDIGO 2024 Guidelines, which recommend patients with advanced CKD to continue treatment with ACE-Is/ARBs.

Keywords: Angiotensin II receptor blockers (ARBs); Angiotensin-converting enzyme inhibitors (ACE-is); Cardio-renal syndromes; Chronic kidney disease (CKD); Heart failure; Ischemic heart disease (IHD).

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Conflict of interest statement

Declarations. Conflict of interest: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. Human and animal rights: This article does not contain any studies with human participants or animals performed by any of the authors. Informed consent: Written informed consent was obtained from all patients involved in the study.

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