What is the role of dual therapy with RASi with regards to CKD?
Dual therapy with RASi have been shown to both 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, that may outweigh any potential CV or kidney benefit. Therefore, it is recommended to avoid any combination of ACEi, ARB, and direct renin inhibitor (DRI) therapy in patients with CKD, with or without diabetes (1B).