Sequential RAAS Blockade: Is It Worth the Risk?

Advances in Chronic Kidney Disease

Volumn 21, Issue 2, 2014, Pages 159-165

  Persson, Frederik ^a,b,c   Rossing, Peter ^a,b,c  

^a STENO DIABETES CENTER   (Denmark)

^b AARHUS UNIVERSITY   (Denmark)

^c UNIVERSITY OF COPENHAGEN   (Denmark)

Author keywords

Chronic kidney disease; Dual blockade; Hyperkalemia; Raas; Renin inhibition

Indexed keywords

ALDOSTERONE; ALDOSTERONE ANTAGONIST; ALDOSTERONE RECEPTOR; ALISKIREN; BENAZEPRIL; CANDESARTAN; DIPEPTIDYL CARBOXYPEPTIDASE INHIBITOR; ENALAPRIL; EPLERENONE; IRBESARTAN; LISINOPRIL; LOSARTAN; OLMESARTAN; POTASSIUM; RAMIPRIL; SPIRONOLACTONE; TELMISARTAN; VALSARTAN;

ADVERSE OUTCOME; ALBUMINURIA; DIABETES MELLITUS; DRUG MEGADOSE; HUMAN; META ANALYSIS (TOPIC); MONOTHERAPY; POTASSIUM BLOOD LEVEL; PRIORITY JOURNAL; PROTEINURIA; RANDOMIZED CONTROLLED TRIAL (TOPIC); RENAL PROTECTION; REVIEW;

CHRONIC KIDNEY DISEASE; DUAL BLOCKADE; HYPERKALEMIA; RAAS; RENIN INHIBITION;

AMIDES; ANGIOTENSIN II TYPE 1 RECEPTOR BLOCKERS; ANGIOTENSIN-CONVERTING ENZYME INHIBITORS; ANTIHYPERTENSIVE AGENTS; DIABETIC NEPHROPATHIES; DRUG THERAPY, COMBINATION; FUMARATES; HUMANS; MINERALOCORTICOID RECEPTOR ANTAGONISTS; RENAL INSUFFICIENCY, CHRONIC; RENIN; RENIN-ANGIOTENSIN SYSTEM; RISK ASSESSMENT; TREATMENT OUTCOME;

EID: 84896823634     PISSN: 15485595     EISSN: 15485609     Source Type: Journal    
DOI: 10.1053/j.ackd.2014.01.003     Document Type: Review

References (61)

1. Hommel E., Parving H.-H., Mathiesen E.R., Edsberg B., Nielsen M.D., Giese J. Effect of captopril on kidney function in insulin-dependent diabetic patients with nephropathy. Br Med J 1986, 293:466-470.
2. Björck S., Mulec H., Johnsen S.A., Nordén G., Aurell M. Renal protective effect of enalapril in diabetic nephropathy. Br Med J 1992, 304:339-343.
3. Lewis E., Hunsicker L., Bain R., Rhode R. The effect of angiotensin-converting-enzyme inhibition on diabetic nephropathy. N Engl J Med 1993, 329:1456-1462.
4. Parving H.-H., Lehnert H., Bröchner-Mortensen J., Gomis R., Andersen S., Arner P. The effect of irbesartan on the development of diabetic nephropathy in patients with type 2 Diabetes. N Engl J Med 2001, 345:870-878.
5. Brenner B.M., Cooper M.E., de Zeeuw D., et al. Effects of losartan on renal and cardiovascular outcomes in patients with type 2 diabetes and nephropathy. N Engl J Med 2001, 345:861-869.
6. Lewis E.J., Hunsicker L.G., Clarke W.R., et al. Renoprotective effect of the angiotensin-receptor antagonist irbesartan in patients with nephropathy due to type 2 diabetes. N Engl J Med 2001, 345:851-860.
7. Chaturvedi N., Sjolie A.K., Stephenson J.M., et al. Effect of lisinopril on progression of retinopathy in normotensive people with type 1 diabetes. Lancet 1998, 351:28-31.
8. Bilous R., Chaturvedi N., Sjolie A.K., et al. Effect of candesartan on microalbuminuria and albumin excretion rate in diabetes: three randomized trials. Ann Intern Med 2009, 151:11-14.
9. Haller H., Ito S., Izzo J.L., et al. Olmesartan for the delay or prevention of microalbuminuria in type 2 diabetes. N Engl J Med 2011, 364:907-917.
10. Ruggenenti P., Fassi A., Ilieva A.P., et al. Preventing microalbuminuria in type 2 diabetes. N Engl J Med 2004, 351:1941-1951.
11. Ruggenenti P., Perna A., Gherardi G., et al. Renoprotective properties of ACE-inhibition in non-diabetic nephropathies with non-nephrotic proteinuria. Lancet 1999, 354:359-364.
12. Hou F.F., Zhang X., Zhang G.H., et al. Efficacy and safety of benazepril for advanced chronic renal insufficiency. N Engl J Med 2006, 354:131-140.
13. Wright J.T., Bakris G., Greene T., et al. Effect of blood pressure lowering and antihypertensive drug class on progression of hypertensive kidney disease: results from the AASK trial. JAMA 2002, 288:2421-2431.
14. de Zeeuw D., Remuzzi G., Parving H.H., et al. Albuminuria, a therapeutic target for cardiovascular protection in type 2 diabetic patients with nephropathy. Circulation 2004, 110:921-927.
15. de Zeeuw D., Remuzzi G., Parving H.-H., et al. Proteinuria, a target for renoprotection in patients with type 2 diabetic nephropathy: lessons from RENAAL. Kidney Int 2004, 65:2309-2320.
16. Eijkelkamp W.B.A., Zhang Z., Remuzzi G., et al. Albuminuria is a target for renoprotective therapy independent from blood pressure in patients with type 2 diabetic nephropathy: post hoc analysis from the Reduction of Endpoints in NIDDM with the Angiotensin II Antagonist Losartan (RENAAL) trial. J Am Soc Nephrol 2007, 18:1540-1546.
17. Kunz R., Wolbers M., Glass T., Mann J.F.E. The COOPERATE trial: a letter of concern. Lancet 2008, 371:1575-1576.
18. Mogensen C.E., Neldam S., Tikkanen I., et al. Randomised controlled trial of dual blockade of renin-angiotensin system in patients with hypertension, microalbuminuria, and non-insulin dependent diabetes: the Candesartan and Lisinopril Microalbuminuria (CALM) study. Br Med J 2000, 321:1440-1444.
19. Jacobsen P., Andersen S., Rossing K., Jensen B.R., Parving H.-H. Dual blockade of the renin-angiotensin system versus maximal recommended dose of ACE inhibition in diabetic nephropathy. Kidney Int 2003, 63:1874-1880.
20. Tan F., Mukherjee J.J., Lee K.O., Lim P., Liew C.F. Dual blockade of the renin-angiotensin-aldosterone system is safe and effective in reducing albuminuria in Asian type 2 diabetic patients with nephropathy. Singapore Med J 2010, 51:151-156.
21. Bakris G.L., Ruilope L., Locatelli F., et al. Treatment of microalbuminuria in hypertensive subjects with elevated cardiovascular risk: Results of the IMPROVE trial. Kidney Int 2007, 72:879-885.
22. Fernandez Juarez G., Luno J., Barrio V., et al. Effect of dual blockade of the renin-angiotensin system on the progression of type 2 diabetic nephropathy: a randomized trial. Am J Kidney Dis 2013, 61:211-218.
23. Schjoedt K.J., Rossing K., Juhl T.R., et al. Beneficial impact of spironolactone in diabetic nephropathy. Kidney Int 2005, 68:2829-2836.
24. Rossing K., Schjoedt K.J., Smidt U.M., Boomsma F., Parving H.H. Beneficial effects of adding spironolactone to recommended antihypertensive treatment in diabetic nephropathy: a randomized, double-masked, cross-over study. Diabetes Care 2005, 28:2106-2112.
25. Mehdi U.F., Adams-Huet B., Raskin P., Vega G.L., Toto R.D. Addition of angiotensin receptor blockade or mineralocorticoid antagonism to maximal angiotensin-converting enzyme inhibition in diabetic nephropathy. J Am Soc Nephrol 2009, 20:2641-2650.
26. Epstein M., Williams G.H., Weinberger M., et al. Selective aldosterone blockade with eplerenone reduces albuminuria in patients with type 2 diabetes. Clin J Am Soc Nephrol 2006, 1:940-951.
27. Frimodt-Moller M., Hoj N.A., Strandgaard S., Kamper A.L. Feasibility of combined treatment with enalapril and candesartan in advanced chronic kidney disease. Nephrol Dial Transplant 2010, 25:842-847.
28. Boesby L., Elung-Jensen T., Klausen T.W., Strandgaard S., Kamper A.L. Moderate antiproteinuric effect of add-on aldosterone blockade with eplerenone in non-diabetic chronic kidney disease. A randomized cross-over study. PLoS One 2011, 6:e26904.
29. Orena S., Maurer T., Eudy R., et al. PF-03882845, a non-steroidal mineralocorticoid receptor antagonist, prevents renal injury with reduced risk of hyperkalemia in an animal model of nephropathy. Front Pharmacol 2013, 4:14.
30. Pitt B., Kober L., Ponikowski P., et al. Safety and tolerability of the novel non-steroidal mineralocorticoid receptor antagonist BAY 94-8862 in patients with chronic heart failure and mild or moderate chronic kidney disease: a randomized, double-blind trial. Eur Heart J 2013, 34:2453-2463.
31. Oparil S., Yarows S.A., Patel S., Fang H., Zhang J., Satlin A. Efficacy and safety of combined use of aliskiren and valsartan in patients with hypertension: a randomised, double-blind trial. Lancet 2007, 370:221-229.
32. Ferdinand K.C., Weitzman R., Purkayastha D., Sridharan K., Jaimes E.A. Aliskiren-based dual- and triple-combination therapies in high-risk US minority patients with Stage 2 hypertension. J Am Soc Hypertens 2012, 6:219-227.
33. Bakris G.L., Oparil S., Purkayastha D., Yadao A.M., Alessi T., Sowers J.R. Randomized study of antihypertensive efficacy and safety of combination aliskiren/valsartan vs valsartan monotherapy in hypertensive participants with type 2 diabetes mellitus. J Clin Hypertens 2013, 15:92-100.
34. Persson F., Rossing P., Reinhard H., et al. Renal effects of aliskiren compared with and in combination with irbesartan in patients with type 2 diabetes, hypertension, and albuminuria. Diabetes Care 2009, 32:1873-1879.
35. Parving H.-H., Persson F., Lewis J.B., Lewis E.J., Hollenberg N.K. Aliskiren combined with losartan in type 2 diabetes and nephropathy. N Engl J Med 2008, 358:2433-2446.
36. Persson F., Lewis J.B., Lewis E.J., Rossing P., Hollenberg N.K., Parving H.H. Aliskiren in combination with losartan reduces albuminuria independent of baseline blood pressure in patients with type 2 diabetes and nephropathy. Clin J Am Soc Nephrol 2011, 6:1025-1031.
37. Parving H.H., Brenner B.M., McMurray J.J., et al. Baseline characteristics in the Aliskiren Trial in Type 2 Diabetes Using Cardio-Renal Endpoints (ALTITUDE). J Renin Angiotensin Aldosterone Syst 2012, 13:387-393.
38. Klahr S. Chronic renal failure: management. Lancet 1991, 338:423-427.
39. Gheorghiade M., Böhm M., Greene S.J. Effect of aliskiren on postdischarge mortality and heart failure readmissions among patients hospitalized for heart failure: the astronaut randomized trial. JAMA 2013, 309:1125-1135.
40. Nicholls S.J., Bakris G.L., Kastelein J.J., et al. Effect of aliskiren on progression of coronary disease in patients with prehypertension: the AQUARIUS randomized clinical trial. JAMA 2013, 310:1135-1144.
41. Kunz R., Friedrich C., Wolbers M., Mann J.F. Meta-analysis: effect of monotherapy and combination therapy with inhibitors of the renin angiotensin system on proteinuria in renal disease. Ann Intern Med 2008, 148:30-48.
42. Makani H., Bangalore S., Desouza K.A., Shah A., Messerli F.H. Efficacy and safety of dual blockade of the renin-angiotensin system: meta-analysis of randomised trials. Br Med J 2013, 346:f360.
43. Harel Z., Gilbert C., Wald R., et al. The effect of combination treatment with aliskiren and blockers of the renin-angiotensin system on hyperkalaemia and acute kidney injury: systematic review and meta-analysis. Br Med J 2012, 344:e42.
44. Chan K.E., Ikizler T.A., Gamboa J.L., Yu C., Hakim R.M., Brown N.J. Combined angiotensin-converting enzyme inhibition and receptor blockade associate with increased risk of cardiovascular death in hemodialysis patients. Kidney Int 2011, 80:978-985.
45. Yusuf S., Teo K.K., Pogue J., et al. Telmisartan, ramipril, or both in patients at high risk for vascular events. N Engl J Med 2008, 358:1547-1559.
46. Mann J.F., Anderson C., Gao P., et al. Dual inhibition of the renin-angiotensin system in high-risk diabetes and risk for stroke and other outcomes: results of the ONTARGET trial. J Hypertens 2013, 31:414-421.
47. Mann J.F., Schmieder R.E., McQueen M., et al. Renal outcomes with telmisartan, ramipril, or both, in people at high vascular risk (the ONTARGET study): a multicentre, randomised, double-blind, controlled trial. Lancet 2008, 372:547-553.
48. Volpe M., Danser A.H., Menard J., et al. Inhibition of the renin-angiotensin-aldosterone system: is there room for dual blockade in the cardiorenal continuum?. J Hypertens 2012, 30:647-654.
49. Imai E., Chan J.C., Ito S., et al. Effects of olmesartan on renal and cardiovascular outcomes in type 2 diabetes with overt nephropathy: a multicentre, randomised, placebo-controlled study. Diabetologia 2011, 54:2978-2986.
50. Parving H.H., Brenner B.M., McMurray J.J., et al. Cardiorenal end points in a trial of aliskiren for type 2 diabetes. N Engl J Med 2012, 367:2204-2213.
51. de Boer R.A., Azizi M., Danser A.J., et al. Dual RAAS suppression: recent developments and implications in light of the ALTITUDE study. J Renin Angiotensin Aldosterone Syst 2012, 13:409-412.
52. Fried L.F., Emanuele N., Zhang J.H., et al. Combined angiotensin inhibition for the treatment of diabetic nephropathy. N Engl J Med 2013, 369:1892-1903.
53. Maione A., Nicolucci A., Craig J.C., et al. Protocol of the Long-term Impact of RAS Inhibition on Cardiorenal Outcomes (LIRICO) randomized trial. J Nephrol 2007, 20:646-655.
54. Persson F., Rossing P., Reinhard H., et al. Optimal antiproteinuric dose of aliskiren in type 2 diabetes mellitus: a randomised crossover trial. Diabetologia 2010, 53:1576-1580.
55. Rossing K., Schjoedt K.J., Jensen B.R., Boomsma F., Parving H.-H. Enhanced renoprotective effects of ultrahigh doses of irbesartan in patients with type 2 diabetes and microalbuminuria. Kidney Int 2005, 68:1190-1198.
56. Weir M.R., Hollenberg N.K., Zappe D.H., et al. Antihypertensive effects of double the maximum dose of valsartan in African-American patients with type 2 diabetes mellitus and albuminuria. J Hypertens 2010, 28:186-193.
57. Schmieder R.E., Klingbeil A.U., Fleischmann E.H., Veelken R., Delles C. Additional antiproteinuric effect of ultrahigh dose candesartan: a double-blind, randomized, prospective study. J Am Soc Nephrol 2005, 16:3038-3045.
58. Burgess E., Muirhead N., Rene de C.P., Chiu A., Pichette V., Tobe S. Supramaximal dose of candesartan in proteinuric renal disease. J Am Soc Nephrol 2009, 20:893-900.
59. Andersen S., Rossing P., Juhl T.R., Deinum J., Parving H.-H. Optimal dose of losartan for renoprotection in diabetic nephropathy. Nephrol Dial Transplant 2002, 17:1413-1418.
60. Schjoedt K.J., Astrup A.S., Persson F., et al. Optimal dose of lisinopril for renoprotection in type 1 diabetic patients with diabetic nephropathy: a randomised crossover trial. Diabetologia 2009, 52:46-49.
61. Hou F.F., Xie D., Zhang X., et al. Renoprotection of Optimal Antiproteinuric Doses (ROAD) study: a randomized controlled study of benazepril and losartan in chronic renal insufficiency. J Am Soc Nephrol 2007, 18:1889-1898.