The use of renin–angiotensin–inhibitors in patients with chronic kidney disease

Publication date: Available online 11 July 2019Source: Canadian Journal of CardiologyAuthor(s): Silvia J. Leon, Navdeep TangriAbstractChronic kidney disease (CKD) is a growing public health issue worldwide. It is acknowledged that CKD is associated with increased risk of cardiovascular disease which is the leading cause of morbidity and mortality in this population. The role of the renin-angiotensin aldosterone system (RAAS) in the pathophysiology of hypertension, cardiovascular and kidney diseases is well known and the RAAS system is a major regulator of blood pressure through its effect on body fluids and electrolyte homeostasis. For two decades, renin-angiotensin system inhibitors (RASi) have been the mainstay of treatment for CKD. Clinical trials have demonstrated that prescription of monotherapy with angiotensin converting enzyme inhibitors (ACEI) or angiotensin receptor blockers (ARB) reduces albuminuria and slows the progression of nephropathy in patients with diabetes. In clinical practice guidelines, RAS inhibitors are recommended as the antihypertensive drug of choice in patients with CKD with or without diabetes. Moreover, RAS inhibitors have shown to offer cardiovascular protection beyond those resulting after blood pressure control. However, the benefits of RASi prescriptions on patients with advanced CKD remain controversial. Patients with advanced CKD or undergoing dialysis are underrepresented in clinical trials, and studies in this population are urgently nee...
Source: Canadian Journal of Cardiology - Category: Cardiology Source Type: research