“Rules are for the guidance of wise men and the obedience of fools.” Group Captain Sir Douglas Bader, 1910–1982
One of the first major guidelines in nephrology was the Dialysis Outcomes Quality Initiatives (DOQI), which later morphed into the KDOQI guidelines that we all know today. Good as they were, they were developed by the National Kidney Foundation, based in the United States, and other countries went their own way. The Canadian Society of Nephrology has had slightly different variations in their guidelines, its last major one from 2011, on the timing of initiation of dialysis (1).
Severe acute respiratory coronavirus 2 (SARS-CoV-2) uses angiotensin-converting enzyme 2 (ACE2) to enter host cells. Early in the pandemic, several basic science studies were often cited and suggested that ACE inhibitors (ACEis) and angiotensin receptor blockers (ARBs) may have an effect to increase the abundance of ACE2 (1). Thus, logic would prevail that if anyone on ACEis or ARBs is at risk of infection, becomes infected, or develops coronavirus infectious disease 2019 (COVID-19), then these should be discontinued. However, the science of the renin angiotensin system (RAS) is far more intricate and interesting. The correct answer is that