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Inicio Medicina Clínica (English Edition) Use of renin–angiotensin–aldosterone system blockade in controversial chroni...
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Vol. 156. Issue 11.
Pages 561-567 (June 2021)
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Vol. 156. Issue 11.
Pages 561-567 (June 2021)
Review
Use of renin–angiotensin–aldosterone system blockade in controversial chronic kidney disease populations
Uso de bloqueantes del sistema renina-angiotensina-aldosterona en poblaciones controvertidas con enfermedad renal crónica
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Ana María García-Prietoa,
Corresponding author
anamgarciaprieto@gmail.com

Corresponding author.
, Úrsula Verdallesa, Marian Goicoecheaa,b
a Nephrology Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
b Red de Investigación Renal (REDinREN), Spain
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Tables (3)
Table 1. Principal studies designed to assess the effect of RAAS blockers among patients with advanced CKD.
Table 2. Principal studies designed to assess the effect of RAAS blockers among patients without proteinuria.
Table 3. Principal studies designed to assess the effect of RAAS blockers among elderly patients.
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Abstract

Renin–angiotensin–aldosterone system blockers have shown to be effective in controlling blood pressure and proteinuria, slowing the progression to end stage renal disease and reducing cardiovascular risk, so they are the mainstream treatment of hypertension in chronic kidney disease. Their beneficial effects have been proven in multiple randomized clinical trials on different study populations, but there has recently been some controversial data on its use in some subgroups of patients, especially those with advanced chronic kidney disease. In some other populations such as patients with non-proteinuric nephropathies or the elderly, who can be more susceptible to its adverse events, their benefits have also been questioned.

The aim of the present review is to collect available published data on the effect of renin–angiotensin–aldosterone system blockers in some controversial populations and provide perspective on future research areas in this field.

Keywords:
Albuminuria
Chronic kidney disease
Hypertension
Elderly
Renin–angiotensin system
Resumen

Los bloqueantes del sistema renina-angiotensina-aldosterona han demostrado ser efectivos en el control de la tensión arterial y la proteinuria, enlenteciendo la progresión a enfermedad renal terminal, y reduciendo el riesgo cardiovascular, por lo que son el tratamiento de primera línea de la hipertensión en pacientes con enfermedad renal crónica. Sus efectos beneficiosos han sido demostrados en múltiples ensayos clínicos en diferentes poblaciones de estudio, pero recientemente se han publicado datos controvertidos a cerca de su uso en determinados subgrupos de pacientes, especialmente aquellos con enfermedad renal crónica avanzada. En otras poblaciones como los pacientes con nefropatías no proteinúricas o en ancianos, que pueden ser especialmente sensibles a sus efectos secundarios, sus beneficios han sido, así mismo cuestionados.

El objetivo de la presente revisión es recoger la evidencia disponible sobre el efecto de los bloqueantes del sistema renina-angiotensina-aldosterona en poblaciones controvertidas y arrojar perspectivas en cuanto a posibles áreas de investigación en este campo.

Palabras clave:
Albuminuria
Enfermedad renal crónica
Hipertensión
Microalbuminuria
Sistema renina-angiotensina

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