期刊
PHARMACOLOGICAL RESEARCH
卷 172, 期 -, 页码 -出版社
ACADEMIC PRESS LTD- ELSEVIER SCIENCE LTD
DOI: 10.1016/j.phrs.2021.105835
关键词
Renin-angiotensin-aldosterone system; RAAS inhibitors; ACE inhibitors; Angiotensin receptor blockers; Mineralocorticoid receptor antagonists; Hyperkalemia
资金
- Canadian Institutes of Health Research Institute of Nutrition, Metabolism and Diabetes [PJT175027]
- Kidney Research Scientist Core Education and National Training (KRESCENT) Program New Investigator Award [2019KP-NIA626990]
- Jindal Research Chair for the Prevention of Kidney Disease
RAAS inhibitors are evidence-based treatments for various conditions, but can lead to hyperkalemia, which increases the risk for cardiovascular events. Managing hyperkalemia while maintaining the benefits of RAAS inhibitors is essential to prevent adverse outcomes.
Renin-angiotensin-aldosterone system (RAAS) inhibitors are evidence-based treatments for a number of conditions including hypertension, diabetes mellitus, chronic kidney disease, and congestive heart failure. Among the most common adverse effects of RAAS inhibitors is hyperkalemia which results from either reduced secretion of aldosterone or increased resistance to aldosterone. Many of the conditions for which RAAS inhibitors are recommended further amplify the risk for hyperkalemia in and of themselves. RAAS inhibitor-related hyperkalemia is associated with an increased risk for cardiovascular events, hospitalizations, and death. Yet discontinuation of RAAS inhibitors for patients with chronic kidney disease and congestive heart failure is also associated with an increased risk for cardiovascular events, hospitalizations, and death. Therefore, clinicians are often left to struggle with the dilemma of the best management approach to RAAS inhibitor-related hyperkalemia. The ideal solution involves pharmacotherapies that are safe and effective in mitigating hyperkalemia and allow patients to continue to receive the beneficial effects from RAAS inhibitors. In this regard, modern pharmacologic agents such as patiromer and zirconium cyclosilicate are providing a mechanism whereby physicians are better equipped to maintain their patients on RAAS inhibitors.
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