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Dual renin-angiotensin-aldosterone system blockade for diabetic kidney disease

Raimund H Pichler1, Ian H de Boer

  • 1Division of Nephrology, University of Washington, Box 356521, 1959 NE Pacific Street, Seattle, WA 98195, USA. rpichler@u.washington.edu

Current Diabetes Reports
|June 10, 2010
PubMed

Insights

Dual renin-angiotensin-aldosterone system (RAAS) blockade is not recommended for most patients with diabetic kidney disease (DKD). Careful consideration of risks and benefits is advised for high-risk individuals pending further clinical trial data.

Area of Science:

  • Nephrology
  • Endocrinology
  • Pharmacology

Background:

  • Diabetic kidney disease (DKD) progression is mitigated by blocking the renin-angiotensin-aldosterone system (RAAS).
  • The efficacy of dual RAAS blockade for improving renal outcomes in DKD remains debated.
  • Current evidence on dual RAAS blockade in DKD requires careful evaluation.

Purpose of the Study:

  • To review the scientific rationale for dual RAAS blockade in DKD.
  • To examine current clinical evidence on dual RAAS blockade for preventing and treating DKD.
  • To provide guidance on the use of dual RAAS blockade in DKD management.

Main Methods:

  • Literature review of scientific rationale and clinical trials.
  • Analysis of evidence regarding dual RAAS blockade in DKD.
  • Synthesis of current data to inform clinical practice.

Main Results:

  • Dual RAAS blockade is not routinely indicated for patients with low to moderate risk of progressive kidney disease.
  • For high-risk DKD patients, potential risks and benefits of dual RAAS blockade must be individualized.
  • Ongoing clinical trials are expected to provide further insights.

Conclusions:

  • Dual RAAS blockade should not be a standard treatment for all DKD patients.
  • Risk-benefit assessment is crucial for high-risk DKD patients considering dual RAAS blockade.
  • Further research is necessary to clarify the role of dual RAAS blockade in DKD.

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