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Am J Med Sci. 2016 Mar;351(3):309-16. doi: 10.1016/j.amjms.2015.12.021.

Effects of Renin-Angiotensin-Aldosterone System Blockade in Patients with End-Stage Renal Disease.

Author information

1
Division of Cardiovascular Diseases, Department of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee.
2
Department of Physician Assistant Studies, Christian Brothers University, Memphis, Tennessee.
3
Department of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee.
4
Division of Nephrology, Department of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee.
5
Methodist University Hospital, Memphis, Tennessee; Department of Clinical Pharmacy, University of Tennessee College of Pharmacy, Memphis, Tennessee.
6
Division of Cardiovascular Diseases, Department of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee. Electronic address: khouzamrami@yahoo.com.

Abstract

Blockers of the renin-angiotensin-aldosterone system (RAAS), such as angiotensin-converting enzyme inhibitors and angiotensin receptor blockers are routinely used in patients with chronic kidney disease because of their cardiovascular (CV) and renoprotective effects. However, there are no uniform recommendations about RAAS blockers for CV protection in the end-stage renal disease (ESRD) population other than the preferred drug class for blood pressure control. This uncertainty stems from the fact that patients with ESRD were generally excluded from randomized controlled trials evaluating the cardioprotective benefits of RAAS blockers. It is important to weigh the potential harms associated with the use of RAAS blockers, such as electrolyte disturbances and worsening anemia, with their role in protection of residual kidney function, alleviation of thirst and potential CV benefits. The objective of this review is to summarize the current knowledge about the use of RAAS blockers in patients with ESRD.

KEYWORDS:

Angiotensin receptor blocker; Angiotensin-converting enzyme inhibitor; End-stage renal disease; Heart failure; Hypertension

PMID:
26992264
DOI:
10.1016/j.amjms.2015.12.021
[Indexed for MEDLINE]

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