Use of renin angiotensin system inhibitors in patients with chronic kidney disease

Abstract

Current guidelines recommend renin angiotensin system inhibitors (RASI) as key components of treatment of hypertension in patients with chronic kidney disease (CKD), because of their effect on reducing the future rate of loss of glomerular filtration rate (GFR). A common risk of RASI in CKD is a haemodynamically mediated, and reversible, fall in GFR of varying severity and duration, any time after commencement of the Inhibitors. A benefit of the acute reduction in filtration rate with RASI may be a reduction in the future rate of loss in GFR: the greatest benefit likely to be in those patients with a greater rate of loss of GFR prior to, and a lesser acute loss of GFR after, introduction of RASI; and in those patients with significant proteinuria. An acute loss of GFR of >25% following the introduction of RASI is an indication to cease the RASI. An acute loss of GFR < 25% requires consideration of the likely risks of the lower GFR and benefits of any future reduced rate of loss of GFR. A fall in GFR in patients while on RASI is usually associated with a remediable cause. When the cause for the fall in GFR is not revealed, and the fall is less than 25%, hopeful expectancy is recommended. Hyperkalaemia in patients with CKD on RASI is more common with more severe disease, potassium retaining diuretics and hypoaldosteronism. Treatment should be modified to maintain a plasma potassium <6 mmol/L.

Jian-Pi-Yi-Shen formula enhances perindopril inhibition of chronic kidney disease progression by activation of SIRT3, modulation of mitochondrial dynamics, and antioxidant effects

“…The evidences in favor of RAS inhibitors are less strong for patients with lower levels of albuminuria (30–300 mg/g creatinine), especially for CKD patients without diabetes [ 22 , 23 ]. In addition, the safety of long-term use of RAS inhibitors and acute reduction in glomerular filtration rate (GFR) following RAS inhibitors are worrying [ 7 ]. Therefore, many patients seek out alternative therapies such as TCHM to treat CKD [ 24 ].…”

“…Moreover, the renal protective effects of RAS inhibitors in different subgroups of CKD patients are not the same (7), and its application is also controversial with the decline of renal function (8). People in many countries around the world use traditional medicinal plants to treat diseases (9).…”

“…Although the application of RAS inhibitors has delayed the progress of CKD in the past decades, the global incidence of ESKD has continued to increase [ 6 ]. Moreover, the renal protective effects of RAS inhibitors in different subgroups of CKD patients are not the same [ 7 ], and its application is also controversial with the decline of renal function [ 8 ]. People in many countries around the world use traditional medicinal plants to treat diseases [ 9 ].…”

A Real-World Analysis of Post-Marketing Surveillance Data Assessing the Incidence of Hyperkalemia or Acute Kidney Injury in Patients on Angiotensin-Converting Enzyme Inhibitors Versus Angiotensin-Receptor Blockers

“…Angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) debuted in the early 1970s; they were first used as antihypertensive agents [ 1 ]. The indications have been gradually expanded to hypertensive heart failure, acute myocardial infarction, diabetic nephropathy, and non-diabetic nephropathy [ 2 ]. These interventions have demonstrated protective effects on cardiac and kidney function [ 3 , 4 ].…”