Why the study?
Does combined renin-angiotensin-aldosterone inhibition improve outcomes compared to single agent therapy in patients with proteinuria?
Does combined renin-angiotensin-aldosterone inhibition improve outcomes compared to single agent therapy in patients with proteinuria?
Current guidelines recommend single RAAS inhibition for albuminuria, as combined therapy increases the risk of hyperkalemia and renal impairment without added benefit.
Proteinuria, in particular albuminuria, is a potentially significant modifiable risk factor for cardiovascular disease and the progression of kidney disease. Current treatment guidelines for albuminuria recommend a single renin–angiotensin–aldosterone inhibitor. This can be an ACE inhibitor or an angiotensin receptor antagonist. The routine use of combined renin–angiotensin–aldosterone inhibition for albuminuria is not supported by current evidence. Combination therapy is associated with higher rates of adverse events such as hyperkalaemia and progressive renal impairment.
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Darren M. Roberts (2020) studied this question.
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