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Renin Angiotensin Aldosterone System Inhibitors in Chronic Kidney Disease: A Difficult Equation

Elias Sanidas1, Dimitrios Papadopoulos1, Michalis Chatzis1

  • 1Department of Cardiology, LAIKO General Hospital, Hypertension Excellence Centre-ESH, 17 Agiou Thoma Street, 11527, Athens, Greece.

American Journal of Cardiovascular Drugs : Drugs, Devices, and Other Interventions
|March 23, 2021
PubMed

Insights

Renin angiotensin aldosterone system (RAAS) blockade is crucial for managing hypertension in chronic kidney disease (CKD). This review clarifies optimal RAAS inhibitor use in CKD patients, including those on hemodialysis.

Area of Science:

  • Nephrology
  • Cardiovascular Medicine
  • Pharmacology

Background:

  • Chronic kidney disease (CKD) is a significant global health issue.
  • Hypertension (HTN) is a common comorbidity in CKD, impairing quality of life.
  • Renin-angiotensin-aldosterone system (RAAS) blockade is the standard for HTN management.

Purpose of the Study:

  • To address the optimal use of RAAS blockade in patients with CKD.
  • To clarify misconceptions regarding RAAS inhibitor use in impaired renal function and hemodialysis patients.
  • To provide evidence-based guidance for managing HTN in CKD.

Main Methods:

  • Systematic review of available clinical data.
  • Analysis of studies excluding patients with impaired renal function.
  • Evaluation of treatment strategies for RAAS blockade in CKD.

Main Results:

  • Limited data exists for RAAS inhibitor use in CKD, particularly in hemodialysis patients.
  • Patients with impaired renal function are often excluded from major clinical trials.
  • Optimal RAAS blockade strategies require further investigation.

Conclusions:

  • Misconceptions exist regarding RAAS inhibitor safety and efficacy in CKD.
  • Further research is needed to establish optimal RAAS blockade protocols for CKD patients.
  • Evidence-based guidelines are necessary for managing HTN in this population.

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