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Renin-Angiotensin-Aldosterone System Blockade in Diabetic Nephropathy. Present Evidences

Luz Lozano-Maneiro1, Adriana Puente-García2

  • 1Division of Nephrology, Department of Internal Medicine, Fuenlabrada University Hospital, Rey Juan Carlos University School of Medicine, Camino del Molino, 2, 28942 Fuenlabrada, Madrid, Spain. llozano@senefro.org.

Journal of Clinical Medicine
|November 17, 2015
PubMed

Insights

Diabetic Kidney Disease (DKD) management focuses on renin-angiotensin-aldosterone system (RAAS) blockade. While RAAS blockade is crucial, combining therapies for enhanced blockade has shown disappointing long-term outcomes.

Area of Science:

  • Nephrology
  • Endocrinology
  • Pharmacology

Background:

  • Diabetic Kidney Disease (DKD) is a primary cause of chronic kidney disease globally, marked by increasing prevalence.
  • DKD patients face elevated risks of mortality, cardiovascular disease, and significant healthcare utilization.
  • Renal dysfunction and end-stage renal disease remain critical concerns in diabetes management.

Purpose of the Study:

  • To review the current status of renin-angiotensin-aldosterone system (RAAS) blockade in Diabetic Kidney Disease (DKD).
  • To examine the efficacy and risks of dual RAAS blockade strategies in DKD.
  • To provide a perspective on the benefits and potential drawbacks of RAAS blockade in DKD.

Main Methods:

  • Review of clinical trials and existing literature on RAAS blockade in DKD.
  • Analysis of studies investigating dual blockade combinations targeting the RAAS pathway.
  • Evaluation of long-term outcomes and patient data related to RAAS inhibition therapies.

Main Results:

  • RAAS blockade is a foundational treatment for DKD, demonstrating proven benefits.
  • Clinical trials combining RAAS-blocking agents for enhanced blockade yielded disappointing long-term outcomes.
  • The review synthesizes current understanding of RAAS blockade's role, including combination therapies.

Conclusions:

  • RAAS blockade remains central to managing Diabetic Kidney Disease.
  • Dual RAAS blockade strategies, while theoretically promising, have not translated to improved long-term outcomes.
  • Further research is needed to optimize RAAS blockade and mitigate risks in DKD patients.

Keywords:
ACE inhibitorsaldosterone antagonistangiotensin receptor blockerscombined RAAS blockadediabetic kidney diseasediabetic nephropathydirect renin inhibitorsdual RAAS blockademineralocorticoid receptor antagonistsrenin-angiotensin-aldosterone system blockade

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