What is the role of dual therapy with RASi in patients with CKD and diabetes with albuminuria?
Dual RASi therapy with an ACEi, ARB, or DRI has been shown to lower BP and slow the progression of certain types of kidney diseases independently of BP control. However, compared to monotherapy with ACEi or ARB, dual RASi therapy appears to cause more adverse effects, including hyperkalemia and AKI, which may outweigh any potential CV or kidney benefit. Thus, we recommend avoiding any combination of ACEi, ARB, and direct renin inhibitor (DRI) therapy in patients with CKD, with or without diabetes.