Key result
Renin-angiotensin system inhibition may cause iatrogenic deterioration of cardiorenal syndrome with anemia, but it reduces mortality and should not be denied without careful evaluation.
Why the study?
Renin-angiotensin system inhibition can worsen renal function and induce anaemia, prompting exploration of whether it acts as an iatrogenic cause of cardiorenal syndrome deterioration.
Does renin-angiotensin system inhibition worsen renal function and anemia or affect mortality in patients with cardiorenal syndrome?
Does renin-angiotensin system inhibition worsen renal function and anemia or affect mortality in patients with cardiorenal syndrome?
Despite the risk of worsening renal function and anemia, RAS inhibition reduces mortality in cardiorenal syndrome and should not be routinely withheld.
: The term 'cardiorenal syndrome' (CRS) was introduced to describe problems related to the simultaneous existence of heart and renal insufficiency. The prevalence of anaemia in CRS is high and increases the risk of hospitalizations and death. Renin-angiotensin system (RAS) inhibition is the cornerstone therapy in cardiovascular and renal medicine. As angiotensin II regulates both glomerular filtration rate (GFR) and erythropoiesis, RAS inhibition can further deteriorate renal function and lower hematocrit or cause anaemia in patients with heart failure. The aim of this review is to explore the relationship among CRS, anemia and administration of angiotensin-converting enzyme inhibitor (ACEi) or angiotensin receptor blocker (ARB) and summarize the evidence suggesting that RAS inhibition may be considered an iatrogenic cause of deterioration of CRS with anemia. It should be emphasized however, that RAS inhibition reduces mortality in both groups with and without worsening of renal function, and therefore, no patient with CRS should be denied an ACEi or ARB trial without careful evaluation.
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Vlahakos et al. (2019) conducted a review in Cardiorenal syndrome with anaemia. Renin-angiotensin system (RAS) inhibition (ACEi or ARB) was evaluated. Renin-angiotensin system inhibition may cause iatrogenic deterioration of cardiorenal syndrome with anemia, but it reduces mortality and should not be denied without careful evaluation.
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