Current Diabetes Reports

, Volume 10, Issue 4, pp 297–305

Dual Renin-Angiotensin-Aldosterone System Blockade for Diabetic Kidney Disease


DOI: 10.1007/s11892-010-0126-2

Cite this article as:
Pichler, R.H. & de Boer, I.H. Curr Diab Rep (2010) 10: 297. doi:10.1007/s11892-010-0126-2


Blockade of the renin-angiotensin-aldosterone system (RAAS) prevents the development and progression of diabetic kidney disease (DKD). It is controversial whether the simultaneous use of two RAAS inhibitors (ie, dual RAAS blockade) further improves renal outcomes. This review examines the scientific rationale and current clinical evidence addressing the use of dual RAAS blockade to prevent and treat DKD. It is concluded that dual RAAS blockade should not be routinely applied to patients with low or moderate risk of progressive kidney disease (normoalbuminuria or microalbuminuria with preserved glomerular filtration rate). For patients with high risk of progressive kidney disease (substantial albuminuria or impaired glomerular filtration rate), clinicians should carefully weigh the potential risks and benefits of dual RAAS blockade on an individual basis until ongoing clinical trials provide further insight.


DiabetesKidneyDiabetic kidney diseaseChronic kidney diseaseReninAngiotensin IIAldosteroneAngiotensin-converting enzyme inhibitorsAngiotensin II receptor blockersAlbuminuriaMicroalbuminuriaGlomerular filtration rate

Clinical Study Acronyms


Aliskiren Trial in Type 2 Diabetes Using Cardio-Renal Endpoints


Aliskiren in the Evaluation of Proteinuria in Diabetes


Combination Treatment of Angiotensin Receptor Blocker and Angiotensin-Converting Enzyme Inhibitor in Nondiabetic Renal Disease


Irbesartan in the Management of Proteinuric Patients at High Risk for Vascular Events


Combination Angiotensin Receptor Blocker and Angiotensin-Converting Enzyme Inhibitor for Treatment of Diabetic Nephropathy


Ongoing Telmisartan Alone and in Combination With Ramipril Global Endpoint Trial


Randomized Aldactone Evaluation Study


Reduction in Endpoints in Non-Insulin Dependent Diabetes Mellitus With the Angiotensin II Antagonist Losartan


Renoprotection of Optimal Antiproteinuric Doses

Copyright information

© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  1. 1.Kidney Research Institute and Division of NephrologyUniversity of WashingtonSeattleUSA
  2. 2.Division of NephrologyUniversity of WashingtonSeattleUSA