Advanced chronic kidney disease: Considerations for renin-angiotensin system inhibitor use as disease processes

Renin-angiotensin system inhibitor (RASI) therapy is the cornerstone of chronic kidney disease (CKD) management and slowing of disease progression. However, debate remains about the use of RASI therapy in advanced CKD. Declining RASI therapy use in CKD may reflect prescribers' lack of confidence given the absence of clear guidelines.

This article reviews evidence for RASI therapy in patients with advanced CKD, with the aim of enhancing general practitioners' (GPs') awareness to the cardiovascular and renoprotective benefits that extend into this population.

There is a myriad of data supporting the use of RASI therapy in patients with CKD. However, the lack of data in advanced CKD remains a critical gap that has the potential to influence progression of disease, time to renal replacement therapy and cardiovascular outcomes. Current practice guidelines support continuation of RASI therapy in the absence of contraindications because of its mortality benefit and potential to preserve renal function.