Optimizing RAASi Therapy for Cardiovascular, Renal Health, with Kam Kalantar-Zadeh, MD, MPH, PhD

The advancements in renin-angiotensin-aldosterone system Inhibitor (RAASi) therapy and their impact on various disease groups, particularly for chronic kidney disease and heart failure, are noteworthy, with recent studies demonstrating their potential to slow disease progression and improve survival rates, especially in diabetic kidney disease.

In an interview with HCPLive, Kam Kalantar-Zadeh, MD, MPH, PhD chief of the Division of Nephrology, Hypertension, and Transplantation at the University of California Irvine Medical Center, discusses his session, presented at the National Kidney Foundation (NKF) 2024 Spring Clinical Meeting, which highlighted dietary challenges, potassium control, and potential solutions related to RAASi therapy. The session, presented by 2 providers and 1 dietician, aimed to offer valuable insights to healthcare providers across various disciplines, fostering engaging discussions and facilitating knowledge exchange essential for enhancing patient care and outcomes in clinical practice.

Notably, 2 out of the 4 guideline-directed medical therapy (GDMT) classes for chronic kidney disease management in diabetes comprise RAASis, underlining their significance. Despite challenges like hyperkalemia, Kalantar-Zadeh believes it is crucial to not abandon the prescribed RAASi dose, and instead emphasizes the need for multidisciplinary collaboration to explore solutions such as dietary modifications and potassium-binding therapies.

Studies like FIDELIO, he explained, have shown promising outcomes in managing diabetic kidney disease with RAASi therapy, albeit with a risk of hyperkalemia, mitigated by effective potassium control strategies using specialized binders. Therefore, further research is warranted to optimize RAASi dosing.

“I think more studies are needed to see how use of potassium binding therapy can allow patients to tolerate and maximize the dose of RAASi [while allowing] patients to enjoy quality of life by having fewer dietary restrictions,” Kalantar-Zadeh said. “As we discussed, most potassium rich diets are among the healthiest food that are invariably recommended for cardiovascular health.”

Disclosures: Kalantar-Zadeh sporadically consults for Vifor Pharma.