Use of Renin-Angiotensin System Blockade in Advanced CKD: An NKF-KDOQI Controversies Report

Matthew R. Weir; Jay I. Lakkis; Bernard Jaar; Michael V. Rocco; Michael J Choi; Holly J. Kramer; Elaine Ku

doi:10.1053/j.ajkd.2018.06.010

Use of Renin-Angiotensin System Blockade in Advanced CKD: An NKF-KDOQI Controversies Report

Matthew R. Weir, Jay I. Lakkis, Bernard Jaar, Michael V. Rocco, Michael J Choi, Holly J. Kramer, Elaine Ku

Johns Hopkins Hospital

Research output: Contribution to journal › Article › peer-review

26 Scopus citations

Abstract

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] < 30 mL/min/1.73 m²). 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.

Original language	English (US)
Pages (from-to)	873-884
Number of pages	12
Journal	American Journal of Kidney Diseases
Volume	72
Issue number	6
DOIs	https://doi.org/10.1053/j.ajkd.2018.06.010
State	Published - Dec 2018

Keywords

RAAS blockade
Renin angiotensin aldosterone system (RAAS)
advanced CKD
angiotensin II receptor blockers (ARBs)
angiotensin converting enzyme inhibitors (ACEi)
blood pressure
cardiovascular risk
chronic kidney disease (CKD)
diabetes
drug safety
end-stage renal disease (ESRD)
estimated glomerular filtration rate (eGFR)
hypertension
mortality
proteinuria
reduced eGFR
renal disease progression

ASJC Scopus subject areas

Nephrology

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10.1053/j.ajkd.2018.06.010

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@article{b91a5d83ef8d4c3aad6084d08e3375bf,

title = "Use of Renin-Angiotensin System Blockade in Advanced CKD: An NKF-KDOQI Controversies Report",

abstract = "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] < 30 mL/min/1.73 m2). 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.",

keywords = "RAAS blockade, Renin angiotensin aldosterone system (RAAS), advanced CKD, angiotensin II receptor blockers (ARBs), angiotensin converting enzyme inhibitors (ACEi), blood pressure, cardiovascular risk, chronic kidney disease (CKD), diabetes, drug safety, end-stage renal disease (ESRD), estimated glomerular filtration rate (eGFR), hypertension, mortality, proteinuria, reduced eGFR, renal disease progression",

author = "Weir, {Matthew R.} and Lakkis, {Jay I.} and Bernard Jaar and Rocco, {Michael V.} and Choi, {Michael J} and Kramer, {Holly J.} and Elaine Ku",

note = "Funding Information: Support: There was no direct financial support for the preparation of this article. Dr Ku was supported by National Institutes of Health grant HL 131023. Dr Weir is supported by U01DK116095-01, R01DK066013, R01HL127422, R01HL132372-01A1, and U01 DK1061022. Publisher Copyright: {\textcopyright} 2018 National Kidney Foundation, Inc.",

year = "2018",

month = dec,

doi = "10.1053/j.ajkd.2018.06.010",

language = "English (US)",

volume = "72",

pages = "873--884",

journal = "American Journal of Kidney Diseases",

issn = "0272-6386",

publisher = "W.B. Saunders Ltd",

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T1 - Use of Renin-Angiotensin System Blockade in Advanced CKD

T2 - An NKF-KDOQI Controversies Report

AU - Weir, Matthew R.

AU - Lakkis, Jay I.

AU - Jaar, Bernard

AU - Rocco, Michael V.

AU - Choi, Michael J

AU - Kramer, Holly J.

AU - Ku, Elaine

N1 - Funding Information: Support: There was no direct financial support for the preparation of this article. Dr Ku was supported by National Institutes of Health grant HL 131023. Dr Weir is supported by U01DK116095-01, R01DK066013, R01HL127422, R01HL132372-01A1, and U01 DK1061022. Publisher Copyright: © 2018 National Kidney Foundation, Inc.

PY - 2018/12

Y1 - 2018/12

N2 - 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] < 30 mL/min/1.73 m2). 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.

AB - 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] < 30 mL/min/1.73 m2). 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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KW - Renin angiotensin aldosterone system (RAAS)

KW - advanced CKD

KW - angiotensin II receptor blockers (ARBs)

KW - angiotensin converting enzyme inhibitors (ACEi)

KW - blood pressure

KW - cardiovascular risk

KW - chronic kidney disease (CKD)

KW - diabetes

KW - drug safety

KW - end-stage renal disease (ESRD)

KW - estimated glomerular filtration rate (eGFR)

KW - hypertension

KW - mortality

KW - proteinuria

KW - reduced eGFR

KW - renal disease progression

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DO - 10.1053/j.ajkd.2018.06.010

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AN - SCOPUS:85052938377

SN - 0272-6386

VL - 72

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EP - 884

JO - American Journal of Kidney Diseases

JF - American Journal of Kidney Diseases

IS - 6

ER -

Use of Renin-Angiotensin System Blockade in Advanced CKD: An NKF-KDOQI Controversies Report

Abstract

Keywords

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