Can ACE Inhibitors and Angiotensin Receptor Blockers Be Detrimental in CKD Patients?

Current epidemiological data from the USA, Europe, Asia and the Indian subcontinent, Africa, the Far East, South America, the Middle East and Eastern Europe all point to the increasing incidence of renal failure encompassing acute kidney injury (AKI), chronic kidney disease (CKD) and endstage renal disease (ESRD). While the explanations for these worldwide epidemics remain speculative, it must be acknowledged that these increases in AKI, CKD and ESRD, happening worldwide, have occurred despite the universal application of strategies of renoprotection over the last 2 decades, more especially the widespread use of angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs). We note that many of the published large renin-angiotensin-aldosterone system (RAAS) blockPublished online: March 7, 2011 Macaulay Onuigbo, MD, MSc, FWACP, FASN Department of Nephrology, Midelfort Clinic Mayo Health System, 1221 Whipple Street Eau Claire, WI 54702 (USA) Tel. +1 715 838 3891, E-Mail onuigbo.macaulay @ mayo.edu © 2011 S. Karger AG, Basel 1660–2110/11/1184–0407$38.00/0 Accessible online at: www.karger.com/nec D ow nl oa de d by : 54 .7 0. 40 .1 1 10 /3 1/ 20 17 7 :0 0: 57 P M Onuigbo Nephron Clin Pract 2011;118:c407–c419 c408 Introduction – The Renal Failure Epidemic around