Why the study?
Does combination therapy of renin-angiotensin-aldosterone system blockade reduce cardiovascular and renal morbidity compared to monotherapy in individuals with increased cardiovascular risk, chronic kidney disease, or diabetic nephropathy?
Does combination therapy of renin-angiotensin-aldosterone system blockade reduce cardiovascular and renal morbidity compared to monotherapy in individuals with increased cardiovascular risk, chronic kidney disease, or diabetic nephropathy?
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Dual RAAS blockade should be avoided in patients with chronic kidney disease due to increased risk of AKI and hyperkalemia without cardiovascular or renal benefits.
PURPOSE OF REVIEW: This review presents the role of combination therapy of renin-angiotensin-aldosterone system blockade on cardiovascular and kidney disease. RECENT FINDINGS: Three large randomized controlled trials comparing combination therapy of renin-angiotensin-aldosterone system blockade to monotherapy in individuals with increased cardiovascular risk, chronic kidney disease, or diabetic nephropathy have been reported. These trials - ONTARGET, ALTITUDE, and VA NEPHRON-D - demonstrated an excess risk of adverse effects [especially acute kidney injury (AKI) and hyperkalemia] with combination therapy, without significant benefit in reducing cardiovascular and renal morbidity. SUMMARY: Current evidence supports avoiding dual renin-angiotensin-aldosterone system blockade in patients with chronic kidney disease. Subsequent studies of dual renin-angiotensin-aldosterone system blockade should examine adverse event risks and renal progression endpoints.
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Chen et al. (2014) studied this question.
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