Dual renin-angiotensin-aldosterone system blockade for diabetic kidney disease.
Blockade of the renin-angiotensin-aldosterone system (RAAS) prevents the development and progression of diabetic kidney disease (DKD). It is controversial whether the simultaneous use of two RAAS inhibitors (ie, dual RAAS blockade) further improves renal outcomes. This review examines the scientific rationale and current clinical evidence addressing the use of dual RAAS blockade to prevent and treat DKD. It is concluded that dual RAAS blockade should not be routinely applied to patients with low or moderate risk of progressive kidney disease (normoalbuminuria or microalbuminuria with preserved glomerular filtration rate). For patients with high risk of progressive kidney disease (substantial albuminuria or impaired glomerular filtration rate), clinicians should carefully weigh the potential risks and benefits of dual RAAS blockade on an individual basis until ongoing clinical trials provide further insight.
Pichler
Raimund H
RH
Division of Nephrology, University of Washington, Box 356521, 1959 NE Pacific Street, Seattle, WA 98195, USA. rpichler@u.washington.edu
de Boer
Ian H
IH
D000419:Albuminuria / Q000517:prevention & control; D000450:Aldosterone / Q000378:metabolism; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000009:adverse effects / Q000494:pharmacology* / Q000627:therapeutic use; D000809:Angiotensins / Q000378:metabolism; D001562:Benzimidazoles / Q000009:adverse effects / Q000627:therapeutic use; D001565:Benzoates / Q000009:adverse effects / Q000627:therapeutic use; D003928:Diabetic Nephropathies / Q000378:metabolism* / Q000517:prevention & control*; D006801:Humans; D006947:Hyperkalemia / Q000139:chemically induced; D008954:Models, Biological; D017257:Ramipril / Q000009:adverse effects / Q000627:therapeutic use; D016032:Randomized Controlled Trials as Topic; D012084:Renin-Angiotensin System / Q000187:drug effects* / Q000502:physiology; D000077333:Telmisartan
D000806:Angiotensin-Converting Enzyme Inhibitors; D000809:Angiotensins; D001562:Benzimidazoles; D001565:Benzoates; D000450:Aldosterone; D017257:Ramipril; D000077333:Telmisartan