Initiating renin-angiotensin system inhibitors in chronic kidney disease

Area of Science:

• Nephrology
• Pharmacology

Background:

• Chronic kidney disease (CKD) is a complex condition affecting kidney structure and function.
• Renin-angiotensin system (RAS) inhibitors are proven treatments for CKD, reducing kidney and cardiovascular risks.

Purpose of the Study:

• To provide an overview of initiating RAS inhibitors in adult CKD patients.
• To highlight current guideline recommendations for RAS inhibitor use.
• To offer practical approaches for managing challenges associated with RAS inhibitors.

Main Methods:

• Review of current literature and clinical guidelines on RAS inhibitor use in CKD.
• Analysis of common barriers to RAS inhibitor initiation and adherence.
• Development of a practical management strategy for clinicians.

Main Results:

• RAS inhibitors are underused, underdosed, and frequently discontinued in CKD management.
• Concerns regarding kidney function changes and hyperkalemia are primary reasons for underuse.
• Current guidelines recommend RAS inhibitors for specific CKD populations.

Conclusions:

• Optimizing the use of RAS inhibitors in CKD is crucial for improving patient outcomes.
• Addressing clinician and patient concerns can enhance initiation and adherence.
• A practical, guideline-informed approach is needed to overcome barriers to RAS inhibitor therapy.