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RAAS blockade in the kidney life-cycle-treatment standard
Diego Moriconi1,2, Clara Garcia-Carro3, Julio Nuñez4,5
1Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy.
Summary
Renin-angiotensin-aldosterone system blockade (RAASb) is vital for kidney and heart health, but its effectiveness varies across kidney disease stages. This review explores RAAS modulation benefits from early disease to transplantation.
Area of Science:
- Nephrology
- Cardiology
- Pharmacology
Background:
- The renin-angiotensin-aldosterone system (RAAS) is crucial for cardiovascular and renal homeostasis.
- Chronic RAAS activation drives kidney disease progression, hypertension, and cardiovascular complications.
- RAAS blockade (RAASb) is a foundational therapy for chronic kidney disease (CKD).
Purpose of the Study:
- To review the efficacy and safety of RAAS modulation across the kidney life cycle.
- To highlight established benefits and areas of clinical uncertainty in RAASb.
- To discuss the role of RAASb in conjunction with newer therapies like SGLT2 inhibitors and GLP-1 receptor agonists.
Main Methods:
- Systematic review of current evidence on RAAS modulation.
- Synthesis of data from primary prevention to advanced CKD, dialysis, and kidney transplantation.
- Analysis of established RAAS inhibitors (ACEi, ARBs, DRIs, MRAs) and novel agents (e.g., finerenone).
Main Results:
- RAASb is beneficial in proteinuric CKD and advanced stages, with limited benefit in non-proteinuric disease.
- Novel non-steroidal MRAs offer enhanced renal and cardiovascular protection, especially in diabetic kidney disease.
- RAASb may preserve residual kidney function in dialysis patients and improve outcomes post-transplant.
Conclusions:
- RAAS modulation is a cornerstone therapy across the kidney life cycle, with tailored benefits.
- Emerging therapies complement RAASb, reshaping treatment strategies for kidney and cardiovascular protection.
- Further research is needed to clarify optimal RAASb use in specific patient populations and stages of kidney disease.
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