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

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Abstract

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.

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Abbreviations

ALTITUDE:

Aliskiren Trial in Type 2 Diabetes Using Cardio-Renal Endpoints

AVOID:

Aliskiren in the Evaluation of Proteinuria in Diabetes

COOPERATE:

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

IMPROVE:

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

NEPHRON-D:

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

ONTARGET:

Ongoing Telmisartan Alone and in Combination With Ramipril Global Endpoint Trial

RALES:

Randomized Aldactone Evaluation Study

RENAAL:

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

ROAD:

Renoprotection of Optimal Antiproteinuric Doses

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Disclosure

Dr. Raimund H. Pichler received honoraria for lectures for Boehringer Ingelheim and for Novartis. Dr. Ian H. de Boer receives research grant funding from Abbott Laboratories.

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Authors and Affiliations

  1. Kidney Research Institute and Division of Nephrology, University of Washington, Box 359606, 325 Nineth Avenue, Seattle, WA, 98104, USA

    Ian H. de Boer

  2. Division of Nephrology, University of Washington, Box 356521, 1959 NE Pacific Street, Seattle, WA, 98195, USA

    Raimund H. Pichler

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  1. Raimund H. Pichler
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  2. Ian H. de Boer
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Correspondence to Ian H. de Boer.

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Pichler, R.H., de Boer, I.H. Dual Renin-Angiotensin-Aldosterone System Blockade for Diabetic Kidney Disease. Curr Diab Rep 10, 297–305 (2010). https://doi.org/10.1007/s11892-010-0126-2

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  • DOI: https://doi.org/10.1007/s11892-010-0126-2

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