The Use of Renin-Angiotensin System Inhibitors in Patients With Chronic Kidney Disease

Leon, Silvia J.; Tangri, Navdeep

doi:10.1016/j.cjca.2019.06.029

Cited by 18 publications

(17 citation statements)

References 56 publications

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“…The RAASi are reno-protective and may slow or even halt the progression of diabetic kidney disease. 11 , 12 Maximized RAAS inhibition, combined with intensified blood-pressure control, amelioration of dyslipidemia, and metabolic control in diabetics in a multimodal approach that includes lifestyle modifications may stabilize renal function and decrease progression among patients with CKD. Our findings contribute to the literature on whether RAASi should be initiated or even continued in patients at risk of HK and/or with worsening kidney function.…”

Section: Discussionmentioning

confidence: 99%

“…9 The renin-angiotensin -aldosterone system (RAAS) blockade plays a pivotal role in delaying, and perhaps halting, kidney failure in most types of CKD. [9][10][11][12] Brenner et al reported that ESRD can be delayed by 2 years in patients with CKD and diabetes mellitus (DM) when a RAAS blockade is induced with the optimal dose of losartan. When a RAAS blockade is induced with losartan, development of ESRD can be delayed by 2 years in patients with nephropathy secondary to type 2 diabetes.…”

Section: Introductionmentioning

confidence: 99%

“…9,[13][14][15][16][17] In light of the above, a predictive model that shows an individual patient's risk of progression to kidney failure could be useful for initiating timely therapeutic interventions that limit nephrotoxin exposure and prevent further reduction in glomerular filtration rate (GFR). 2,9,11,12 Such a model could be helpful in clinical decision-making as well as public health interventions to improve both clinical and cost outcomes of CKD. 9,18 Very few existing predictive models for CKD progression possess the ideal characteristics of having good internal and external validity and being clinically useful.…”

Section: Introductionmentioning

confidence: 99%

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A Predictive Model for Progression of Chronic Kidney Disease to Kidney Failure Using a Large Administrative Claims Database

Dai

Alvarez

Woods

2021

CEOR

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Background To create an appropriate chronic kidney disease (CKD) management program, we developed a predictive model to identify patients in a large administrative claims database with CKD stages 3 or 4 who were at high risk for progression to kidney failure. Methods The predictive model was developed and validated utilizing a subset of patients with CKD stages 3 or 4 derived from a large Aetna claims database. The study spanned 36 months, comprised of a 12-month (2015) baseline period and a 24-month (2016–2017) prediction period. All patients were ≥18 years of age and continuously enrolled for 36 months. Multivariate logistic regression was used to develop models. Prediction model performance measures included area under the receiver operating characteristic curve (AUROC), calibration, and gain and lift charts. Results Of the 74,114 patients identified as having CKD stages 3 or 4 during the baseline period, 2476 (3.3%) had incident kidney failure during the prediction period. The predictive model included the effect of numerous variables, including age, gender, CKD stage, hypertension (HTN), diabetes mellitus (DM), congestive heart failure, peripheral vascular disease, anemia, hyperkalemia (HK), prospective episode risk group score, and poor adherence to renin-angiotensin-aldosterone system inhibitors. The strongest predictors of progression to kidney failure were CKD stage (4 vs 3), HTN, DM, and HK. The ROC and calibration analyses in the validation sample demonstrated good predictive accuracy (AUROC=0.844) and calibration. The top two prediction deciles identified 70.8% of patients who progressed to kidney failure during the prediction period. Conclusion This novel predictive model had good accuracy for identifying, from a large national database, patients with CKD who were at high risk of progressing to kidney failure within 2 years. Early identification using this model could potentially lead to improved health outcomes and reduced healthcare expenditures in this at-risk population.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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A Predictive Model for Progression of Chronic Kidney Disease to Kidney Failure Using a Large Administrative Claims Database

Dai

Alvarez

Woods

2021

CEOR

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“…The renin-angiotensin-aldosterone system (RAAS) is the body's primary mechanism for regulating blood pressure through its effects on fluid and sodium balance [26]. Renin, a hormone synthesized in the kidney, is the rate-limiting step in the RAAS; the absence of renin inhibits the RAAS cascade [27].…”

Section: Fluid Balance and Blood Pressurementioning

confidence: 99%

Chronic Kidney Disease: Role of Diet for a Reduction in the Severity of the Disease

Naber¹,

Purohit²

2021

Preprint

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Chronic kidney disease is a critical health crisis in the US, affecting about 37 million adults. Known as "the silent killer" because it is often undiagnosed until it has reached a stage of progression. Renal dysfunction causes many adverse effects to the body's biological mechanisms, such as fluid electrolyte and pH balance, blood pressure regulation, excretion of toxins and waste, vitamin D metabolism, and hormonal regulation. Many CKD patients experience hyperkalemia, hyperphosphatemia, chronic metabolic acidosis, bone deterioration, blood pressure abnormalities, and edema. Symptoms experienced may be minimized, and the disease's progression may be slowed through an appropriate diet, which is why medical nutrition therapy is a critical aspect of the medical intervention for CKD. The current KDOQI recommendations are proposed as well as the physiological mechanisms behind the recommendations. Current biological explanations of the effects of a whole foods plant-based diet are included for possible contrast with the current renal diet. Strong evidence continues to support the importance of proper nutrition in the prevention and progression of kidney disease.

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“…Most of the functions inducing blood pressure elevation are mediated through binding of ANG-II to angiotensin type 1 receptor (AT 1 R), whereas, binding of ANG-II to angiotensin type II receptors (AT 2 R) has been reported to generally oppose the actions of AT 1 R. Other peptides of the RAS, such as ANG-(1-7) and alamandine, also act to counter regulate the action of ANG-II at AT 1 R [3,4]. Drugs targeting the RAS are effective as treatments for hypertension and other diseases including heart failure, chronic kidney disease, diabetic nephropathy, Marfan's syndrome, and some autoimmune diseases [5][6][7][8][9][10]. However, it is unclear why these drugs are effective even in patients exhibiting low or normal circulating renin activity [11,12].…”

Section: Introductionmentioning

confidence: 99%

The Renin-Angiotensin System in the Central Nervous System and Its Role in Blood Pressure Regulation

et al. 2020

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Purpose of the Review The main goal of this article is to discuss how the development of state-of-the-art technology has made it possible to address fundamental questions related to how the renin-angiotensin system (RAS) operates within the brain from the neurophysiological and molecular perspective. Recent Findings The existence of the brain RAS remains surprisingly controversial. New sensitive in situ hybridization techniques and novel transgenic animals expressing reporter genes have provided pivotal information of the expression of RAS genes within the brain. We discuss studies using genetically engineered animals combined with targeted viral microinjections to study molecular mechanisms implicated in the regulation of the brain RAS. We also discuss novel drugs targeting the brain RAS that have shown promising results in clinical studies and trials. Summary Over the last 50 years, several new physiological roles of the brain RAS have been identified. In the coming years, efforts to incorporate cutting-edge technologies such as optogenetics, chemogenetics, and single-cell RNA sequencing will lead to dramatic advances in our full understanding of how the brain RAS operates at molecular and neurophysiological levels. Keywords Renin. Prorenin receptor. Angiotensin receptor. Biased agonist. Blood pressure. Neurophysiology This article is part of the Topical Collection on Inflammation and Cardiovascular Diseases

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The Use of Renin-Angiotensin System Inhibitors in Patients With Chronic Kidney Disease

Cited by 18 publications

References 56 publications

A Predictive Model for Progression of Chronic Kidney Disease to Kidney Failure Using a Large Administrative Claims Database

A Predictive Model for Progression of Chronic Kidney Disease to Kidney Failure Using a Large Administrative Claims Database

Chronic Kidney Disease: Role of Diet for a Reduction in the Severity of the Disease

The Renin-Angiotensin System in the Central Nervous System and Its Role in Blood Pressure Regulation

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