Commentary |

The Hazards of Dual Renin-Angiotensin Blockade in Chronic Kidney Disease

Elaine Ku, MD; Jeanie Park, MD; Jay Vidhun, MD; Vito Campese, MD
Arch Intern Med. 2009;169(11):1015-1018. doi:10.1001/archinternmed.2009.128.
Text Size: A A A
Published online


Chronic kidney disease (CKD) is increasing in prevalence in the United States. Therapies that can retard the progression of CKD are needed to prevent the morbidity and mortality associated with reduced renal function. Although multiple studies published in the past 10 years have supported the combination use of angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs) to decrease proteinuria and delay disease progression, it is our position that combinations of ACE inhibitors and ARBs should be used with great caution in patients with CKD. We do not dispute that ACE inhibitors or ARBs used as monotherapy can decrease proteinuria and retard progression of renal disease. However, in combination, the risks of adverse effects, including hyperkalemia, hypotension, and worsening renal failure, could outweigh the purported benefits of dual blockade. Until more studies are conducted on the safety of dual renin-angiotensin blockade on the average patient in the community who has CKD, the simultaneous use of ACE inhibitors and ARBs should be discouraged in primary care.

Sign In to Access Full Content

Don't have Access?

Register and get free email Table of Contents alerts, saved searches, PowerPoint downloads, CME quizzes, and more

Subscribe for full-text access to content from 1998 forward and a host of useful features

Activate your current subscription (AMA members and current subscribers)

Purchase Online Access to this article for 24 hours

First Page Preview

View Large
First page PDF preview





Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).
Submit a Comment


Some tools below are only available to our subscribers or users with an online account.

Web of Science® Times Cited: 8

Sign In to Access Full Content

Related Content

Customize your page view by dragging & repositioning the boxes below.

Articles Related By Topic
Related Topics
PubMed Articles