RAAS blockers in patients with chronic renal disease

Abstract:

Progressive loss of renal function, as a fundamental feature of chronic renal disease (CKD), with a high risk of cardiovascular (CV) incidents presents an important clinical challenge. The use of renin-angiotensin-aldosterone system (RAAS) inhibitors is justified practically in all stages of CKD, primarily due to positive cardioprotective and renoprotective effects. This review is emphasizing RCT-approved RAAS inhibitors in CKD treatment. Irbesartan and losartan are recommended in treatment of diabetic nephropathy, ramipril is the drug of choice for CKD with high proteinuria. Ramipril, trandolapril, lisinopril and perindopril applied as RAAS inhibition slow CKD progression, lower proteinuria levels, and drastically reduce the incidence of CV events, cardiovascular and overall mortality. Nevertheless, RAAS blockade brings risks associated with the development of hyperkalemia, hypotension and acute kidney injury (AKI). RAAS inhibition is recommended for its protective effect on the heart, blood vessels and kidneys, it outweighs the impact of arterial hypertension control, while the risks can be minimized by patient adherence to recommended measures and detailed clinical monitoring.

Key words:
chronic kidney disease; renin angiotensin aldosterone system