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Current Options for Kidney Protection: Are Renin-Angiotensin System Inhibitors Still Relevant?

Waichi Wong1

  • 1Boston, Massachusetts.

Seminars in Nephrology
|June 30, 2026
PubMed

Insights

Renin-angiotensin-aldosterone system (RAAS) inhibition remains crucial for slowing chronic kidney disease progression. Newer therapies complement RAAS inhibitors, offering enhanced kidney and cardiovascular benefits.

Area of Science:

  • Nephrology
  • Cardiovascular Medicine
  • Pharmacology

Background:

  • Chronic kidney disease (CKD) involves complex mechanisms like hemodynamic stress, proteinuria, inflammation, fibrosis, and metabolic issues.
  • Barry Brenner's hyperfiltration hypothesis identified these as key drivers of kidney injury.
  • Renin-angiotensin-aldosterone system (RAAS) inhibition revolutionized CKD treatment by slowing progression and improving outcomes.

Purpose of the Study:

  • To review the evolution of CKD treatment strategies.
  • To highlight the enduring role of RAAS inhibitors and the emergence of new therapeutic classes.
  • To discuss advancements in CKD prognostic assessment.

Main Methods:

  • Literature review of landmark trials and therapeutic advancements in CKD.
  • Analysis of the role of RAAS inhibition in kidney protection.
  • Examination of novel therapeutic agents and prognostic tools.

Main Results:

  • RAAS inhibitors are a cornerstone of CKD management, significantly slowing disease progression.
  • Newer therapeutic classes offer additional kidney and cardiovascular benefits.
  • Prognostic assessment has advanced with biomarkers, genetics, imaging, and digital tools, but clinical integration is ongoing.

Conclusions:

  • RAAS inhibitors remain essential for kidney protection in CKD.
  • Emerging therapies complement, rather than replace, established RAAS inhibitor treatments.
  • Integrated prognostic tools are needed for comprehensive CKD management.
Keywords:
angiotensin II receptor blockers (ARBs)angiotensin pathwayangiotensin-converting enzyme (ACE) Inhibitorschronic kidney disease (CKD)glomerular diseasesrenin–angiotensin–aldosterone system (RAAS)

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