Key result
RAAS inhibitors are not inherently nephrotoxic; their continued use after acute kidney injury is beneficial, while dual RAAS blockade should be reserved for carefully selected patients.
Why the study?
Concerns exist regarding potential side effects of dual RAAS blockade and the perception that ACE-Is or ARBs may cause acute kidney injury or accelerate CKD.
Does treatment with RAAS inhibitors or dual RAAS blockade improve outcomes without causing structural nephrotoxicity in patients with kidney and cardiovascular diseases?
Does treatment with RAAS inhibitors or dual RAAS blockade improve outcomes without causing structural nephrotoxicity in patients with kidney and cardiovascular diseases?
This review clarifies that ACE-Is and ARBs are not inherently nephrotoxic and advocates for their continued use in appropriate clinical scenarios, including post-AKI and heart failure, while reassessing the limited role of dual RAAS blockade.
Answers are grounded in this paper and cite their sources.
Supports RAAS inhibitor continuation post-AKI; leaves open dual blockade criteria for future trials.
Drugs that act by inhibiting the renin–angiotensin–aldosterone system (RAAS), such as angiotensin-converting enzyme inhibitors (ACE-Is) and angiotensin II receptor type 1 (AT1) blockers (ARBs), have been recognized as a basic canon of nephroprotection for years. They are commonly used in monotherapy for glomerulonephritis with proteinuria. At present, they are rarely used in combination therapy in a form of dual blockade of RAAS due to concern about possible side effects. On the other hand, both ACE-Is and ARBs are also wrongly referred to as nephrotoxic drugs. The significance of therapy with these drugs is seen in evoking acute kidney injury (AKI) or acceleration of CKD. The aim of this article was to clarify the opinion on the relationship between ACE-Is or ARBs treatment and AKI occurrence, and to attempt to reassess the role of dual RAAS blockade in the treatment of kidney diseases. The principles of heart failure (HF) therapy with ACE-Is or ARBs and current data on the importance of RAAS dual blockade in hypertension are also discussed.
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Donderski et al. (2020) conducted a review in Kidney and cardiovascular diseases. RAAS inhibitors (ACE-Is and ARBs) was evaluated. RAAS inhibitors are not inherently nephrotoxic; their continued use after acute kidney injury is beneficial, while dual RAAS blockade should be reserved for carefully selected patients.
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