The Critical Role of RAASi Therapy in Chronic Kidney Disease, with Wei Ling Lau, MD

Consistency in medication adherence is crucial for maximizing the benefits of renin–angiotensin–aldosterone system inhibitors (RAASi) medications, particularly in reducing heart failure events, hospitalizations, stroke mortality, and maintaining blood pressure control and urine protein levels over the long term. Interrupting therapy intermittently, such as needing to pause treatment due to high potassium levels and then restarting it, can disrupt desired outcomes. However, with the availability of strategies to address potassium issues, patients can feel more confident about staying on their medications without encountering complications.

In an interview with HCPLive,Wei Ling Lau, MD, interim chief in the Division of Nephrology, Hypertension & Kidney Transplantation at the University of California, Irvine, discusses her session on enabling optimal RAASi therapy, presented at the National Kidney Foundation (NKF) 2024 Spring Clinical Meeting.

Numerous studies, she noted, have extensively documented the significant cardiovascular benefits of RAASi therapy in chronic kidney disease. Interrupting RAASi therapy, whether due to high potassium levels, side effects, or other reasons, has been associated with increased risks of heart failure and premature mortality. Consequently, healthcare providers should aim to maintain patients on RAASi therapy consistently to optimize their cardiovascular health outcomes. Historically, concerns about RAASi therapy contributing to a decline in kidney function have led to hesitancy in continuing treatment, with fears of worsening kidney disease. However, recent evidence, including findings from the STOP-ACEi clinical trial, has debunked this notion, demonstrating that discontinuing RAASi therapy does not affect the rate of kidney function decline over time.

Maintaining a balanced approach is essential, particularly regarding dietary potassium intake. While it is important to avoid excessive consumption of high-potassium foods, such as fruits and vegetables, these items are integral to a healthy lifestyle and overall well-being. According to Lau, the importance of a balanced diet and adherence to RAASi therapy is crucial for patient health. Additionally, incorporating newer oral potassium binders into chronic management strategies can help mitigate potassium-related concerns, allowing for a more heart-healthy diet while continuing essential medications for heart and kidney health.

Disclosures: Lau has no relevant disclosures to report.