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Renin-Angiotensin-Aldosterone System Blockade (RAASB) After Acute Kidney Injury: The Controversy Thickens on If and

Macaulay A Onuigbo1

  • 1Medicine, The Robert Larner, M.D. College of Medicine, University of Vermont, Burlington, USA.

Cureus
|January 1, 2024
PubMed

Insights

Renin-angiotensin-aldosterone system blockade (RAASB) offers cardiorenal protection in chronic kidney disease (CKD). However, outcomes after RAASB discontinuation in advanced CKD remain debated, prompting further investigation into patient management.

Area of Science:

  • Nephrology
  • Cardiology
  • Pharmacology

Background:

  • Renin-angiotensin-aldosterone system blockade (RAASB) is widely accepted for cardiorenal protection in diabetic and nondiabetic chronic kidney disease (CKD).
  • Conflicting retrospective data exist regarding renal and cardiovascular mortality outcomes after RAASB discontinuation in advanced CKD.
  • This editorial examines a recent study on renal and mortality outcomes in hospitalized veterans, comparing those restarted on RAASB versus those not.

Discussion:

  • The editorial addresses the ongoing controversy surrounding the management of RAASB in advanced CKD.
  • It highlights the need for clarity on whether to resume RAASB in hospitalized patients with advanced kidney disease.
  • The analysis of veteran outcomes provides critical data for this complex clinical decision.

Key Insights:

  • The study reviewed renal and mortality outcomes in hospitalized veterans with advanced CKD.
  • Comparison was made between patients who were restarted on RAASB and those who were not.
  • Findings contribute to the understanding of RAASB's role in advanced CKD management.

Outlook:

  • Further research is needed to definitively establish optimal RAASB management strategies in advanced CKD.
  • Clinical guidelines may need revision based on emerging evidence regarding RAASB discontinuation and reinitiation.
  • Understanding patient-specific factors influencing outcomes after RAASB management is crucial.

Keywords:
ace inhibitor (acei)acute kidney injury (aki)angiotensin receptor blocker (arb)chronic kidney disease (ckd)late onset renal failure from angiotensin blockade (lorffab)renin-angiotensin-aldosterone system blockade (raasb)

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