title: Renin-Angiotensin-Aldosterone System Blockade in Diabetic Nephropathy. Present Evidences.
abstract: Diabetic Kidney Disease (DKD) is the leading cause of chronic kidney disease in developed countries and its prevalence has increased dramatically in the past few decades. These patients are at an increased risk for premature death, cardiovascular disease, and other severe illnesses that result in frequent hospitalizations and increased health-care utilization. Although much progress has been made in slowing the progression of diabetic nephropathy, renal dysfunction and the development of end-stage renal disease remain major concerns in diabetes. Dysregulation of the renin-angiotensin-aldosterone system (RAAS) results in progressive renal damage. RAAS blockade is the cornerstone of treatment of DKD, with proven efficacy in many arenas. The theoretically-attractive option of combining these medications that target different points in the pathway, potentially offering a more complete RAAS blockade, has also been tested in clinical trials, but long-term outcomes were disappointing. This review examines the "state of play" for RAAS blockade in DKD, dual blockade of various combinations, and a perspective on its benefits and potential risks.
authors.affiliation: Division of Nephrology, Department of Internal Medicine, Fuenlabrada University Hospital, Rey Juan Carlos University School of Medicine, Camino del Molino, 2, 28942 Fuenlabrada, Madrid, Spain. llozano@senefro.org.
authors.forename: Luz
authors.initials: L
authors.lastname: Lozano-Maneiro
authors.affiliation: Division of Nephrology, Department of Internal Medicine, Fuenlabrada University Hospital, Rey Juan Carlos University School of Medicine, Camino del Molino, 2, 28942 Fuenlabrada, Madrid, Spain. apuente@doctor.com.
authors.forename: Adriana
authors.initials: A
authors.lastname: Puente-García
keywords: ACE inhibitors; aldosterone antagonist; angiotensin receptor blockers; combined RAAS blockade; diabetic kidney disease; diabetic nephropathy; direct renin inhibitors; dual RAAS blockade; mineralocorticoid receptor antagonists; renin-angiotensin-aldosterone system blockade