Key result
RAAS inhibitors reduce mortality and hospitalizations in HFrEF and slow CKD progression.
Why the study?
While the outpatient benefits of RAAS inhibitors in chronic heart failure and chronic kidney disease are established, their role and advantages during inpatient hospitalization for acute heart failure are less clear.
Do renin-angiotensin-aldosterone system inhibitors improve outcomes in patients with heart failure and chronic kidney disease?
Do renin-angiotensin-aldosterone system inhibitors improve outcomes in patients with heart failure and chronic kidney disease?
This narrative review reinforces the established benefits of RAAS inhibitors in chronic heart failure and chronic kidney disease, while highlighting the nuanced considerations for their use and discontinuation in acute heart failure settings.
Answers are grounded in this paper and cite their sources.
Supports RAAS inhibitor use in chronic HFrEF with CKD; leaves open optimal strategies and RCT needs in HFpEF, ADHF, and advanced CKD.
Renin-angiotensin-aldosterone system (RAAS) inhibitors are the key medications for patients with heart failure and chronic kidney disease. Multiple randomized controlled trials have demonstrated their benefits in an outpatient setting for the treatment of chronic heart failure. Additional advantages in acute heart failure treatment during inpatient hospitalization are less clear but a small number of non-randomized studies have favored their use. Conditions that result in stoppage of RAAS inhibitors during inpatient stay are an increase in serum creatinine, hyperkalemia, and hemodynamic instability such as hypotension. The role of RAAS inhibitors in chronic kidney disease has also been documented in multiple randomized controlled trials, with their use in hypertension and proteinuria being unambiguous. This narrative review summarizes the role of RAAS inhibitors in acute and chronic heart failure and chronic kidney disease.
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Singhania et al. (2020) conducted a review in Heart failure and chronic kidney disease. Renin-angiotensin-aldosterone system (RAAS) inhibitors (ACEIs, ARBs, MRAs, ARNIs) vs. Placebo or standard of care was evaluated. RAAS inhibitors significantly reduce mortality and hospitalizations in chronic HFrEF and slow CKD progression, though RCT evidence in HFpEF, ADHF, and advanced CKD remains limited.
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