Use of Renin-Angiotensin System Blockade in Advanced CKD: An NKF-KDOQI Controversies Report
Multiple clinical trials have demonstrated that renin-angiotensin system (RAS) blockade with either angiotensin-converting enzyme inhibitors or angiotensin receptor blockers effectively reduces chronic kidney disease (CKD) progression. However, most clinical trials excluded participants with advance...
Ausführliche Beschreibung
Gespeichert in:
| Autor*in: |
Weir, Matthew R. [verfasserIn] |
|---|
| Format: |
E-Artikel |
|---|---|
| Sprache: |
Englisch |
| Erschienen: |
2018transfer abstract |
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| Schlagwörter: |
angiotensin converting enzyme inhibitors (ACEi) end-stage renal disease (ESRD) estimated glomerular filtration rate (eGFR) Renin angiotensin aldosterone system (RAAS) |
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| Umfang: |
12 |
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| Übergeordnetes Werk: |
Enthalten in: The Audio Recorded Cognitive Screen: Outpatient reports on the experience of being tested - 2013, AJKD : official journal of the National Kidney Foundation, Philadelphia, Pa |
|---|---|
| Übergeordnetes Werk: |
volume:72 ; year:2018 ; number:6 ; pages:873-884 ; extent:12 |
| Links: |
|---|
| DOI / URN: |
10.1053/j.ajkd.2018.06.010 |
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ELV04496921X |
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| 245 | 1 | 0 | |a Use of Renin-Angiotensin System Blockade in Advanced CKD: An NKF-KDOQI Controversies Report |
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| 520 | |a Multiple clinical trials have demonstrated that renin-angiotensin system (RAS) blockade with either angiotensin-converting enzyme inhibitors or angiotensin receptor blockers effectively reduces chronic kidney disease (CKD) progression. However, most clinical trials excluded participants with advanced CKD (ie, estimated glomerular filtration rate [eGFR]<30mL/min/1.73m2). It is acknowledged that initiation of RAS blockade is often associated with an acute reduction in eGFR, which is thought to be functional, but may result in long-term preservation of kidney function through the reductions in glomerular intracapillary pressure conferred by these agents. In this National Kidney Foundation–Kidney Disease Outcomes Quality Initiative (NKF-KDOQI) report, we discuss the controversies regarding use of RAS blockade in patients with advanced kidney disease. We review available published data on this topic and provide perspective on the impact of RAS blockade on changes in eGFRs and potassium levels. We conclude that more research is needed to evaluate the therapeutic index of RAS blockade in patients with advanced CKD. | ||
| 520 | |a Multiple clinical trials have demonstrated that renin-angiotensin system (RAS) blockade with either angiotensin-converting enzyme inhibitors or angiotensin receptor blockers effectively reduces chronic kidney disease (CKD) progression. However, most clinical trials excluded participants with advanced CKD (ie, estimated glomerular filtration rate [eGFR]<30mL/min/1.73m2). It is acknowledged that initiation of RAS blockade is often associated with an acute reduction in eGFR, which is thought to be functional, but may result in long-term preservation of kidney function through the reductions in glomerular intracapillary pressure conferred by these agents. In this National Kidney Foundation–Kidney Disease Outcomes Quality Initiative (NKF-KDOQI) report, we discuss the controversies regarding use of RAS blockade in patients with advanced kidney disease. We review available published data on this topic and provide perspective on the impact of RAS blockade on changes in eGFRs and potassium levels. We conclude that more research is needed to evaluate the therapeutic index of RAS blockade in patients with advanced CKD. | ||
| 650 | 7 | |a blood pressure |2 Elsevier | |
| 650 | 7 | |a renal disease progression |2 Elsevier | |
| 650 | 7 | |a proteinuria |2 Elsevier | |
| 650 | 7 | |a drug safety |2 Elsevier | |
| 650 | 7 | |a chronic kidney disease (CKD) |2 Elsevier | |
| 650 | 7 | |a RAAS blockade |2 Elsevier | |
| 650 | 7 | |a angiotensin converting enzyme inhibitors (ACEi) |2 Elsevier | |
| 650 | 7 | |a end-stage renal disease (ESRD) |2 Elsevier | |
| 650 | 7 | |a estimated glomerular filtration rate (eGFR) |2 Elsevier | |
| 650 | 7 | |a mortality |2 Elsevier | |
| 650 | 7 | |a Renin angiotensin aldosterone system (RAAS) |2 Elsevier | |
| 650 | 7 | |a cardiovascular risk |2 Elsevier | |
| 650 | 7 | |a angiotensin II receptor blockers (ARBs) |2 Elsevier | |
| 650 | 7 | |a advanced CKD |2 Elsevier | |
| 650 | 7 | |a reduced eGFR |2 Elsevier | |
| 650 | 7 | |a hypertension |2 Elsevier | |
| 650 | 7 | |a diabetes |2 Elsevier | |
| 700 | 1 | |a Lakkis, Jay I. |4 oth | |
| 700 | 1 | |a Jaar, Bernard |4 oth | |
| 700 | 1 | |a Rocco, Michael V. |4 oth | |
| 700 | 1 | |a Choi, Michael J. |4 oth | |
| 700 | 1 | |a Kramer, Holly J. |4 oth | |
| 700 | 1 | |a Ku, Elaine |4 oth | |
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10.1053/j.ajkd.2018.06.010 doi GBV00000000000431.pica (DE-627)ELV04496921X (ELSEVIER)S0272-6386(18)30796-0 DE-627 ger DE-627 rakwb eng 610 VZ 530 VZ 52.56 bkl Weir, Matthew R. verfasserin aut Use of Renin-Angiotensin System Blockade in Advanced CKD: An NKF-KDOQI Controversies Report 2018transfer abstract 12 nicht spezifiziert zzz rdacontent nicht spezifiziert z rdamedia nicht spezifiziert zu rdacarrier Multiple clinical trials have demonstrated that renin-angiotensin system (RAS) blockade with either angiotensin-converting enzyme inhibitors or angiotensin receptor blockers effectively reduces chronic kidney disease (CKD) progression. However, most clinical trials excluded participants with advanced CKD (ie, estimated glomerular filtration rate [eGFR]<30mL/min/1.73m2). It is acknowledged that initiation of RAS blockade is often associated with an acute reduction in eGFR, which is thought to be functional, but may result in long-term preservation of kidney function through the reductions in glomerular intracapillary pressure conferred by these agents. In this National Kidney Foundation–Kidney Disease Outcomes Quality Initiative (NKF-KDOQI) report, we discuss the controversies regarding use of RAS blockade in patients with advanced kidney disease. We review available published data on this topic and provide perspective on the impact of RAS blockade on changes in eGFRs and potassium levels. We conclude that more research is needed to evaluate the therapeutic index of RAS blockade in patients with advanced CKD. Multiple clinical trials have demonstrated that renin-angiotensin system (RAS) blockade with either angiotensin-converting enzyme inhibitors or angiotensin receptor blockers effectively reduces chronic kidney disease (CKD) progression. However, most clinical trials excluded participants with advanced CKD (ie, estimated glomerular filtration rate [eGFR]<30mL/min/1.73m2). It is acknowledged that initiation of RAS blockade is often associated with an acute reduction in eGFR, which is thought to be functional, but may result in long-term preservation of kidney function through the reductions in glomerular intracapillary pressure conferred by these agents. In this National Kidney Foundation–Kidney Disease Outcomes Quality Initiative (NKF-KDOQI) report, we discuss the controversies regarding use of RAS blockade in patients with advanced kidney disease. We review available published data on this topic and provide perspective on the impact of RAS blockade on changes in eGFRs and potassium levels. We conclude that more research is needed to evaluate the therapeutic index of RAS blockade in patients with advanced CKD. blood pressure Elsevier renal disease progression Elsevier proteinuria Elsevier drug safety Elsevier chronic kidney disease (CKD) Elsevier RAAS blockade Elsevier angiotensin converting enzyme inhibitors (ACEi) Elsevier end-stage renal disease (ESRD) Elsevier estimated glomerular filtration rate (eGFR) Elsevier mortality Elsevier Renin angiotensin aldosterone system (RAAS) Elsevier cardiovascular risk Elsevier angiotensin II receptor blockers (ARBs) Elsevier advanced CKD Elsevier reduced eGFR Elsevier hypertension Elsevier diabetes Elsevier Lakkis, Jay I. oth Jaar, Bernard oth Rocco, Michael V. oth Choi, Michael J. oth Kramer, Holly J. oth Ku, Elaine oth Enthalten in Elsevier Saunders The Audio Recorded Cognitive Screen: Outpatient reports on the experience of being tested 2013 AJKD : official journal of the National Kidney Foundation Philadelphia, Pa (DE-627)ELV011405082 volume:72 year:2018 number:6 pages:873-884 extent:12 https://doi.org/10.1053/j.ajkd.2018.06.010 Volltext GBV_USEFLAG_U GBV_ELV SYSFLAG_U GBV_ILN_11 GBV_ILN_40 52.56 Regenerative Energieformen alternative Energieformen VZ AR 72 2018 6 873-884 12 |
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10.1053/j.ajkd.2018.06.010 doi GBV00000000000431.pica (DE-627)ELV04496921X (ELSEVIER)S0272-6386(18)30796-0 DE-627 ger DE-627 rakwb eng 610 VZ 530 VZ 52.56 bkl Weir, Matthew R. verfasserin aut Use of Renin-Angiotensin System Blockade in Advanced CKD: An NKF-KDOQI Controversies Report 2018transfer abstract 12 nicht spezifiziert zzz rdacontent nicht spezifiziert z rdamedia nicht spezifiziert zu rdacarrier Multiple clinical trials have demonstrated that renin-angiotensin system (RAS) blockade with either angiotensin-converting enzyme inhibitors or angiotensin receptor blockers effectively reduces chronic kidney disease (CKD) progression. However, most clinical trials excluded participants with advanced CKD (ie, estimated glomerular filtration rate [eGFR]<30mL/min/1.73m2). It is acknowledged that initiation of RAS blockade is often associated with an acute reduction in eGFR, which is thought to be functional, but may result in long-term preservation of kidney function through the reductions in glomerular intracapillary pressure conferred by these agents. In this National Kidney Foundation–Kidney Disease Outcomes Quality Initiative (NKF-KDOQI) report, we discuss the controversies regarding use of RAS blockade in patients with advanced kidney disease. We review available published data on this topic and provide perspective on the impact of RAS blockade on changes in eGFRs and potassium levels. We conclude that more research is needed to evaluate the therapeutic index of RAS blockade in patients with advanced CKD. Multiple clinical trials have demonstrated that renin-angiotensin system (RAS) blockade with either angiotensin-converting enzyme inhibitors or angiotensin receptor blockers effectively reduces chronic kidney disease (CKD) progression. However, most clinical trials excluded participants with advanced CKD (ie, estimated glomerular filtration rate [eGFR]<30mL/min/1.73m2). It is acknowledged that initiation of RAS blockade is often associated with an acute reduction in eGFR, which is thought to be functional, but may result in long-term preservation of kidney function through the reductions in glomerular intracapillary pressure conferred by these agents. In this National Kidney Foundation–Kidney Disease Outcomes Quality Initiative (NKF-KDOQI) report, we discuss the controversies regarding use of RAS blockade in patients with advanced kidney disease. We review available published data on this topic and provide perspective on the impact of RAS blockade on changes in eGFRs and potassium levels. We conclude that more research is needed to evaluate the therapeutic index of RAS blockade in patients with advanced CKD. blood pressure Elsevier renal disease progression Elsevier proteinuria Elsevier drug safety Elsevier chronic kidney disease (CKD) Elsevier RAAS blockade Elsevier angiotensin converting enzyme inhibitors (ACEi) Elsevier end-stage renal disease (ESRD) Elsevier estimated glomerular filtration rate (eGFR) Elsevier mortality Elsevier Renin angiotensin aldosterone system (RAAS) Elsevier cardiovascular risk Elsevier angiotensin II receptor blockers (ARBs) Elsevier advanced CKD Elsevier reduced eGFR Elsevier hypertension Elsevier diabetes Elsevier Lakkis, Jay I. oth Jaar, Bernard oth Rocco, Michael V. oth Choi, Michael J. oth Kramer, Holly J. oth Ku, Elaine oth Enthalten in Elsevier Saunders The Audio Recorded Cognitive Screen: Outpatient reports on the experience of being tested 2013 AJKD : official journal of the National Kidney Foundation Philadelphia, Pa (DE-627)ELV011405082 volume:72 year:2018 number:6 pages:873-884 extent:12 https://doi.org/10.1053/j.ajkd.2018.06.010 Volltext GBV_USEFLAG_U GBV_ELV SYSFLAG_U GBV_ILN_11 GBV_ILN_40 52.56 Regenerative Energieformen alternative Energieformen VZ AR 72 2018 6 873-884 12 |
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10.1053/j.ajkd.2018.06.010 doi GBV00000000000431.pica (DE-627)ELV04496921X (ELSEVIER)S0272-6386(18)30796-0 DE-627 ger DE-627 rakwb eng 610 VZ 530 VZ 52.56 bkl Weir, Matthew R. verfasserin aut Use of Renin-Angiotensin System Blockade in Advanced CKD: An NKF-KDOQI Controversies Report 2018transfer abstract 12 nicht spezifiziert zzz rdacontent nicht spezifiziert z rdamedia nicht spezifiziert zu rdacarrier Multiple clinical trials have demonstrated that renin-angiotensin system (RAS) blockade with either angiotensin-converting enzyme inhibitors or angiotensin receptor blockers effectively reduces chronic kidney disease (CKD) progression. However, most clinical trials excluded participants with advanced CKD (ie, estimated glomerular filtration rate [eGFR]<30mL/min/1.73m2). It is acknowledged that initiation of RAS blockade is often associated with an acute reduction in eGFR, which is thought to be functional, but may result in long-term preservation of kidney function through the reductions in glomerular intracapillary pressure conferred by these agents. In this National Kidney Foundation–Kidney Disease Outcomes Quality Initiative (NKF-KDOQI) report, we discuss the controversies regarding use of RAS blockade in patients with advanced kidney disease. We review available published data on this topic and provide perspective on the impact of RAS blockade on changes in eGFRs and potassium levels. We conclude that more research is needed to evaluate the therapeutic index of RAS blockade in patients with advanced CKD. Multiple clinical trials have demonstrated that renin-angiotensin system (RAS) blockade with either angiotensin-converting enzyme inhibitors or angiotensin receptor blockers effectively reduces chronic kidney disease (CKD) progression. However, most clinical trials excluded participants with advanced CKD (ie, estimated glomerular filtration rate [eGFR]<30mL/min/1.73m2). It is acknowledged that initiation of RAS blockade is often associated with an acute reduction in eGFR, which is thought to be functional, but may result in long-term preservation of kidney function through the reductions in glomerular intracapillary pressure conferred by these agents. In this National Kidney Foundation–Kidney Disease Outcomes Quality Initiative (NKF-KDOQI) report, we discuss the controversies regarding use of RAS blockade in patients with advanced kidney disease. We review available published data on this topic and provide perspective on the impact of RAS blockade on changes in eGFRs and potassium levels. We conclude that more research is needed to evaluate the therapeutic index of RAS blockade in patients with advanced CKD. blood pressure Elsevier renal disease progression Elsevier proteinuria Elsevier drug safety Elsevier chronic kidney disease (CKD) Elsevier RAAS blockade Elsevier angiotensin converting enzyme inhibitors (ACEi) Elsevier end-stage renal disease (ESRD) Elsevier estimated glomerular filtration rate (eGFR) Elsevier mortality Elsevier Renin angiotensin aldosterone system (RAAS) Elsevier cardiovascular risk Elsevier angiotensin II receptor blockers (ARBs) Elsevier advanced CKD Elsevier reduced eGFR Elsevier hypertension Elsevier diabetes Elsevier Lakkis, Jay I. oth Jaar, Bernard oth Rocco, Michael V. oth Choi, Michael J. oth Kramer, Holly J. oth Ku, Elaine oth Enthalten in Elsevier Saunders The Audio Recorded Cognitive Screen: Outpatient reports on the experience of being tested 2013 AJKD : official journal of the National Kidney Foundation Philadelphia, Pa (DE-627)ELV011405082 volume:72 year:2018 number:6 pages:873-884 extent:12 https://doi.org/10.1053/j.ajkd.2018.06.010 Volltext GBV_USEFLAG_U GBV_ELV SYSFLAG_U GBV_ILN_11 GBV_ILN_40 52.56 Regenerative Energieformen alternative Energieformen VZ AR 72 2018 6 873-884 12 |
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10.1053/j.ajkd.2018.06.010 doi GBV00000000000431.pica (DE-627)ELV04496921X (ELSEVIER)S0272-6386(18)30796-0 DE-627 ger DE-627 rakwb eng 610 VZ 530 VZ 52.56 bkl Weir, Matthew R. verfasserin aut Use of Renin-Angiotensin System Blockade in Advanced CKD: An NKF-KDOQI Controversies Report 2018transfer abstract 12 nicht spezifiziert zzz rdacontent nicht spezifiziert z rdamedia nicht spezifiziert zu rdacarrier Multiple clinical trials have demonstrated that renin-angiotensin system (RAS) blockade with either angiotensin-converting enzyme inhibitors or angiotensin receptor blockers effectively reduces chronic kidney disease (CKD) progression. However, most clinical trials excluded participants with advanced CKD (ie, estimated glomerular filtration rate [eGFR]<30mL/min/1.73m2). It is acknowledged that initiation of RAS blockade is often associated with an acute reduction in eGFR, which is thought to be functional, but may result in long-term preservation of kidney function through the reductions in glomerular intracapillary pressure conferred by these agents. In this National Kidney Foundation–Kidney Disease Outcomes Quality Initiative (NKF-KDOQI) report, we discuss the controversies regarding use of RAS blockade in patients with advanced kidney disease. We review available published data on this topic and provide perspective on the impact of RAS blockade on changes in eGFRs and potassium levels. We conclude that more research is needed to evaluate the therapeutic index of RAS blockade in patients with advanced CKD. Multiple clinical trials have demonstrated that renin-angiotensin system (RAS) blockade with either angiotensin-converting enzyme inhibitors or angiotensin receptor blockers effectively reduces chronic kidney disease (CKD) progression. However, most clinical trials excluded participants with advanced CKD (ie, estimated glomerular filtration rate [eGFR]<30mL/min/1.73m2). It is acknowledged that initiation of RAS blockade is often associated with an acute reduction in eGFR, which is thought to be functional, but may result in long-term preservation of kidney function through the reductions in glomerular intracapillary pressure conferred by these agents. In this National Kidney Foundation–Kidney Disease Outcomes Quality Initiative (NKF-KDOQI) report, we discuss the controversies regarding use of RAS blockade in patients with advanced kidney disease. We review available published data on this topic and provide perspective on the impact of RAS blockade on changes in eGFRs and potassium levels. We conclude that more research is needed to evaluate the therapeutic index of RAS blockade in patients with advanced CKD. blood pressure Elsevier renal disease progression Elsevier proteinuria Elsevier drug safety Elsevier chronic kidney disease (CKD) Elsevier RAAS blockade Elsevier angiotensin converting enzyme inhibitors (ACEi) Elsevier end-stage renal disease (ESRD) Elsevier estimated glomerular filtration rate (eGFR) Elsevier mortality Elsevier Renin angiotensin aldosterone system (RAAS) Elsevier cardiovascular risk Elsevier angiotensin II receptor blockers (ARBs) Elsevier advanced CKD Elsevier reduced eGFR Elsevier hypertension Elsevier diabetes Elsevier Lakkis, Jay I. oth Jaar, Bernard oth Rocco, Michael V. oth Choi, Michael J. oth Kramer, Holly J. oth Ku, Elaine oth Enthalten in Elsevier Saunders The Audio Recorded Cognitive Screen: Outpatient reports on the experience of being tested 2013 AJKD : official journal of the National Kidney Foundation Philadelphia, Pa (DE-627)ELV011405082 volume:72 year:2018 number:6 pages:873-884 extent:12 https://doi.org/10.1053/j.ajkd.2018.06.010 Volltext GBV_USEFLAG_U GBV_ELV SYSFLAG_U GBV_ILN_11 GBV_ILN_40 52.56 Regenerative Energieformen alternative Energieformen VZ AR 72 2018 6 873-884 12 |
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10.1053/j.ajkd.2018.06.010 doi GBV00000000000431.pica (DE-627)ELV04496921X (ELSEVIER)S0272-6386(18)30796-0 DE-627 ger DE-627 rakwb eng 610 VZ 530 VZ 52.56 bkl Weir, Matthew R. verfasserin aut Use of Renin-Angiotensin System Blockade in Advanced CKD: An NKF-KDOQI Controversies Report 2018transfer abstract 12 nicht spezifiziert zzz rdacontent nicht spezifiziert z rdamedia nicht spezifiziert zu rdacarrier Multiple clinical trials have demonstrated that renin-angiotensin system (RAS) blockade with either angiotensin-converting enzyme inhibitors or angiotensin receptor blockers effectively reduces chronic kidney disease (CKD) progression. However, most clinical trials excluded participants with advanced CKD (ie, estimated glomerular filtration rate [eGFR]<30mL/min/1.73m2). It is acknowledged that initiation of RAS blockade is often associated with an acute reduction in eGFR, which is thought to be functional, but may result in long-term preservation of kidney function through the reductions in glomerular intracapillary pressure conferred by these agents. In this National Kidney Foundation–Kidney Disease Outcomes Quality Initiative (NKF-KDOQI) report, we discuss the controversies regarding use of RAS blockade in patients with advanced kidney disease. We review available published data on this topic and provide perspective on the impact of RAS blockade on changes in eGFRs and potassium levels. We conclude that more research is needed to evaluate the therapeutic index of RAS blockade in patients with advanced CKD. Multiple clinical trials have demonstrated that renin-angiotensin system (RAS) blockade with either angiotensin-converting enzyme inhibitors or angiotensin receptor blockers effectively reduces chronic kidney disease (CKD) progression. However, most clinical trials excluded participants with advanced CKD (ie, estimated glomerular filtration rate [eGFR]<30mL/min/1.73m2). It is acknowledged that initiation of RAS blockade is often associated with an acute reduction in eGFR, which is thought to be functional, but may result in long-term preservation of kidney function through the reductions in glomerular intracapillary pressure conferred by these agents. In this National Kidney Foundation–Kidney Disease Outcomes Quality Initiative (NKF-KDOQI) report, we discuss the controversies regarding use of RAS blockade in patients with advanced kidney disease. We review available published data on this topic and provide perspective on the impact of RAS blockade on changes in eGFRs and potassium levels. We conclude that more research is needed to evaluate the therapeutic index of RAS blockade in patients with advanced CKD. blood pressure Elsevier renal disease progression Elsevier proteinuria Elsevier drug safety Elsevier chronic kidney disease (CKD) Elsevier RAAS blockade Elsevier angiotensin converting enzyme inhibitors (ACEi) Elsevier end-stage renal disease (ESRD) Elsevier estimated glomerular filtration rate (eGFR) Elsevier mortality Elsevier Renin angiotensin aldosterone system (RAAS) Elsevier cardiovascular risk Elsevier angiotensin II receptor blockers (ARBs) Elsevier advanced CKD Elsevier reduced eGFR Elsevier hypertension Elsevier diabetes Elsevier Lakkis, Jay I. oth Jaar, Bernard oth Rocco, Michael V. oth Choi, Michael J. oth Kramer, Holly J. oth Ku, Elaine oth Enthalten in Elsevier Saunders The Audio Recorded Cognitive Screen: Outpatient reports on the experience of being tested 2013 AJKD : official journal of the National Kidney Foundation Philadelphia, Pa (DE-627)ELV011405082 volume:72 year:2018 number:6 pages:873-884 extent:12 https://doi.org/10.1053/j.ajkd.2018.06.010 Volltext GBV_USEFLAG_U GBV_ELV SYSFLAG_U GBV_ILN_11 GBV_ILN_40 52.56 Regenerative Energieformen alternative Energieformen VZ AR 72 2018 6 873-884 12 |
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Multiple clinical trials have demonstrated that renin-angiotensin system (RAS) blockade with either angiotensin-converting enzyme inhibitors or angiotensin receptor blockers effectively reduces chronic kidney disease (CKD) progression. However, most clinical trials excluded participants with advanced CKD (ie, estimated glomerular filtration rate [eGFR]<30mL/min/1.73m2). It is acknowledged that initiation of RAS blockade is often associated with an acute reduction in eGFR, which is thought to be functional, but may result in long-term preservation of kidney function through the reductions in glomerular intracapillary pressure conferred by these agents. In this National Kidney Foundation–Kidney Disease Outcomes Quality Initiative (NKF-KDOQI) report, we discuss the controversies regarding use of RAS blockade in patients with advanced kidney disease. We review available published data on this topic and provide perspective on the impact of RAS blockade on changes in eGFRs and potassium levels. We conclude that more research is needed to evaluate the therapeutic index of RAS blockade in patients with advanced CKD. |
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Multiple clinical trials have demonstrated that renin-angiotensin system (RAS) blockade with either angiotensin-converting enzyme inhibitors or angiotensin receptor blockers effectively reduces chronic kidney disease (CKD) progression. However, most clinical trials excluded participants with advanced CKD (ie, estimated glomerular filtration rate [eGFR]<30mL/min/1.73m2). It is acknowledged that initiation of RAS blockade is often associated with an acute reduction in eGFR, which is thought to be functional, but may result in long-term preservation of kidney function through the reductions in glomerular intracapillary pressure conferred by these agents. In this National Kidney Foundation–Kidney Disease Outcomes Quality Initiative (NKF-KDOQI) report, we discuss the controversies regarding use of RAS blockade in patients with advanced kidney disease. We review available published data on this topic and provide perspective on the impact of RAS blockade on changes in eGFRs and potassium levels. We conclude that more research is needed to evaluate the therapeutic index of RAS blockade in patients with advanced CKD. |
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Multiple clinical trials have demonstrated that renin-angiotensin system (RAS) blockade with either angiotensin-converting enzyme inhibitors or angiotensin receptor blockers effectively reduces chronic kidney disease (CKD) progression. However, most clinical trials excluded participants with advanced CKD (ie, estimated glomerular filtration rate [eGFR]<30mL/min/1.73m2). It is acknowledged that initiation of RAS blockade is often associated with an acute reduction in eGFR, which is thought to be functional, but may result in long-term preservation of kidney function through the reductions in glomerular intracapillary pressure conferred by these agents. In this National Kidney Foundation–Kidney Disease Outcomes Quality Initiative (NKF-KDOQI) report, we discuss the controversies regarding use of RAS blockade in patients with advanced kidney disease. We review available published data on this topic and provide perspective on the impact of RAS blockade on changes in eGFRs and potassium levels. We conclude that more research is needed to evaluate the therapeutic index of RAS blockade in patients with advanced CKD. |
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