ABSTRACT
Drugs that block the renin-angiotensinaldosterone system (RAAS) have demonstrated important utility as part of multidrug regimens in slowing the progression of renal disease as evidenced by statistical reduction in the risk for doubling of serum creatinine or preventing the need for dialysis or transplantation.1,2 The predominant clinical trial evidence supporting the angiotensin-converting enzyme inhibitor (ACEI) is in patients with type 1 diabetes,1 and nondiabetic renal disease.2 The clinical trial evidence supporting the benefit of angiotensin II receptor blockers (ARBs) is derived from clinical trials in patients with type 2 diabetes and incipient nephropathy.3,4 In these large clinical trial experiences with drugs that block the RAAS, there was a very low incidence (2%) of cessation of drug therapy due to increases in serum creatinine or potassium, particularly when these drugs were utilized in patients with
a serum creatinine of 3 mg/dL or less.5,6
Moreover, there is also evidence that drugs that block the RAAS provide a greater relative risk reduction for progression of renal disease, the higher the serum creatinine at baseline prior to study entry.1 Despite these observations, health care providers are notoriously overcautious about the use of drugs that block RAAS in system in patients with even mild degrees of renal insufficiency and frequently deny their patients the benefits of these drugs. This is particularly important when one considers the safety and clearly established benefits of these drugs for slowing the progression of renal disease, and the opportunity for preventing progression of cardiovascular disease.7
