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Does Blockade of the Renin-Angiotensin-Aldosterone System Slow Progression of All Forms of Kidney Disease?

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Abstract

The velocity of chronic kidney disease (CKD) progression is only partly dependent on the nature and activity of the underlying disease process. Activation of the renin-angiotensin-aldosterone system (RAAS) is a crucial, and often universal, event responsible for the pathophysiologic mechanisms that accelerate CKD progression. Thus, it would appear that interruption of the RAAS through the use of angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, mineralocorticoid receptor antagonists, or direct renin inhibitors can play a principal role in slowing CKD progression, regardless of the cause. Unfortunately, applying this generalized approach to all forms of CKD has been delayed by the lack of strong, evidence-based data. The aim of this review is to provide the most current evidence available for the use of RAAS blockade as a method of slowing the progression of the various forms of CKD.

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Abbreviations

AASK:

African American Study of Kidney Disease

ACCOMPLISH:

Avoiding Cardiovascular Events through Combination Therapy in Patients Living with Systolic Hypertension

ALTITUDE:

Aliskiren Trial in Type 2 Diabetes Using Cardio-Renal Endpoints

AVOID:

Aliskiren in the Evaluation of Proteinuria in Diabetes

HALT PKD:

Halt Progression of Polycystic Kidney Disease

HKVIN:

Hong Kong Study using Valsartan n IgA Nephropathy

IDNT:

Irbesartan in Diabetic Nephropathy Trial

MDRD:

Modification of Diet in Renal Disease

ONTARGET:

Ongoing Telmisartan Alone and in Combination with Ramipril Global Endpoint Trial

REIN:

Ramipril Efficacy in Nephropathy

RENAAL:

Reduction of Endpoints in NIDDM with the Angiotensin II Antagonist Losartan

VA NEPHRON-D:

Veterans Affairs Nephropathy in Diabetes

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Disclosure

Dr. Weir has received consulting fees from Amgen, Novartis, NicOx, and Daiichi Sankyo. No other potential conflicts of interest relevant to this article were reported.

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  1. Division of Nephrology, University of Maryland School of Medicine Medical Center, 22 South Greene Street, Room N3W143, Baltimore, MD, 21201, USA

    Michael R. Lattanzio & Matthew R. Weir

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Correspondence to Matthew R. Weir.

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Lattanzio, M.R., Weir, M.R. Does Blockade of the Renin-Angiotensin-Aldosterone System Slow Progression of All Forms of Kidney Disease?. Curr Hypertens Rep 12, 369–377 (2010). https://doi.org/10.1007/s11906-010-0142-2

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