Zannad F, et al., N Engl J Med 2011;364:11-21, 19. UpToDate. An unmet need exists for new hyperkalemia management guidelines that effectively incorporate classification and monitoring for hyperkalemia, optimization of renin-angiotensin-aldosterone system inhibitor (RAASi) therapy, and use of the newer potassium (K +) binders. Who is At Risk for Hyperkalemia? McMurray JJV, et al., N Engl J med. Gheorghiade M, et al., Congest heart fail. 2020, 3' education - Sep. 7, 2020 - Prof. Renato D. Lopes, MD, PhD, 5' education - Aug. 27, 2017 - ESC 2017, Barcelona, Spain, 10' education - June 12, 2018 - Prof. Frank Visseren - Utrecht, The Netherlands - Online CME, 10' education - June 12, 2018 - Prof. Richard Hobbs - Oxford, UK - Online CME, 10' education - June 6, 2018 - Prof. Kees Hovingh - Amsterdam, The Netherlands - Online CME, 5' education - Nov. 23, 2020 - Prof. Deepak Bhatt, MD, 3' education - Oct. 27, 2020 - Prof. Kausik Ray, MD, 10' education - Oct. 26, 2020 - Prof. Ulrich Laufs, MD, 10' education - Nov. 3, 2020 - Prof. Erik Stroes, MD, 10' education - Nov. 9, 2020 - Prof. John Kastelein, MD, 3' education - Mar. A dramatic effect on mortality in patients that did not receive or discontinued therapy with RAASi was reported by a Swedish registry (6). - Circ Heart Fail 2020, 10' education - Aug. 27, 2018 - Burkert Pieske, MD - Berlin, Germany - Online CME, Slides (presentation) - Aug. 27, 2018 - Carolyn Lam, MD - Singapore, 10' education - Aug. 27, 2018 - Barry Borlaug - Rochester, MN, USA - Online CME, Literature - Dec. 8, 2020 - Elbatreek MH, et al. 22, 2018 - Filippo Crea, Angelyn Bethel, Eduard Montanya - Online CME, 10' education - Nov. 24, 2020 - Prof. Francesco Cosentino, MD, 3' education - Dec. 15, 2020 - Prof. van der Meer, MD, PhD, Literature - Dec. 8, 2020 - Unlu O, et al. 2020, 10' education - Sep. 21, 2020 - Fabrice Martens, MD, PhD, prof. Matthew Budoff, MD and prof. Gabriel Steg MD. - Eur Heart J 2017, 3' education - Sep. 2, 2020 - Prof. Isabelle van Gelder, MD. 2020, 10' education - Nov. 24, 2020 - Anthony Fauci, MD. Reeder GS. The risk doubled compared with patients receiving the therapy, regardless of having renal insufficiency. ARBs), while angioedema and hyperkalemia may occur in both ARBs and ACE inhibitor use. Add favourite. 2012;18:9-17, 4. Renin angiotensin aldosterone system inhibitors/antagonists/blockers (RAASi) are a cornerstone in treatment of patients with cardiovascular diseases especially in those with heart failure (HF) due to their proven effect on surrogate and hard endpoints. RAASi therapy was comprised of ACE inhibitors, ARBs, renin inhibitors and MRAs Furuland et al. Cooper WO, Hernandez-diaz S, Arbogast PG, et al. Drugs.com provides accurate and independent information on more than 24,000 prescription drugs, over-the-counter medicines and natural products. However, their preventive value needs to be investigated. BMC Nephrology (2018) 19:211 Page 6 of 16 increased unce rtainty of the ass ociation bet ween hyperk a- Unfortunately, these events are frequently associated with HF (2-4). Definition of Hyperkalemia. Rossignol P, et al., Circ Heart Fail. This activity is intended for nephrologists, cardiologists, and primary care physicians. We list the most important contraindications. We balanced our views on efficacy with the safety data. Standards of Medical Care in Diabetes 2016. - PLoS Biol 2020, Literature - Sep. 28, 2020 - Mayl JJ et al. RAASi before starting therapy and between 1 and 2 weeks thereafter as well as after each dose increase to stress the importance of potassium level monitoring during treatment [25, 31] . 2020, Literature - Nov. 9, 2020 - Ndrepepa G, et al. 7, 2018 - Prof Guntram Schernthaner - Vienna, Austria - Online CME, Literature - Dec. 15, 2020 - You SC, et al. This should ease skepticism about the real-world therapeutic opportunity for SGLT2i, as any benefits due to the SGLT2i can be viewed as being additional to those from RAASi therapy. telemedicine. Do not combine direct renin inhibitors with ACE inhibitors or ARBs, especially in patients with diabetes or pre-existing kidney disease!References:[17][18][19][20][21], , which increases the retention of water and sodium, Contraindications for ACE inhibitors and ARBs, : GFR is already decreased and further reduction may lead to. Methods: A patient-level simulation model was designed to fully characterise the natural history of CKD over a lifetime horizon, and predict the associations between serum potassium levels, RAASi use … Data of the ESC heart failure registry revealed that while ACEi or ARBs were quite frequently prescribed by practitioners, MRAs were not offered to ~30% of the eligible HF patients with reduced ejection fraction (HFrEF) (1). Causes of Hyperkalemia. SZC DDIs. 2015 Jan 15;372(3):222-31. Find out what is the full meaning of RAASI on Abbreviations.com! Dürrenmatt Hall. Hyperkalaemia can be prevented by monitoring potassium levels, which can be done by e.g. Lazich I, et al., Semin Nephrol. Major Side Effects of Angiotensin-Converting Enzyme Inhibitors and Angiotensin II Receptor Blockers. Using ACE inhibitors appropriately. Only potassium levels above 5.5 mmol/L increase the risk of mortality (7), meaning that there is not much concern when potassium levels are elevated but stay below 5 mmol/L. mmol/l) alongside standard treatment with insulin -glucose and salbutamol. - Eur Heart J. Vardeny O, et al., Circ Heart Fail 2014;7:573-579, 8. 2020, 10' education - Aug. 31, 2019 - Prof. Kausik Ray, MD, Slides (presentation) - Oct. 7, 2019 - Prof Francesco Cosentino, MD, Stockholm, Sweden - CME symposium held during ESC 2019, 10' education - Sep. 30, 2019 - Paris, France - Prof. Francesco Cosentino, MD, 10' education - Oct. 4, 2019 - Prof. Brian Ference, MD, Slides (presentation) - Sep. 9, 2019 - ESC Paris, France - Prof. Brian A. Ference, M.D, University of Cambridge, United Kingdom - CME symposium held during ESC 2019, 5' education - Sep. 9, 2019 - Paris, France - Prof. François Mach, 10' education - Mar. Major congenital malformations after first-trimester exposure to ACE inhibitors. They are particularly important in the treatment of hypertensive diabetic patients, as they prevent the development of diabetic nephropathy. However, said Zannad, ‘dose reduction or discontinuation is not always needed, as hyperkalaemia is just a very expected adverse event of RAASi’. Acute Versus Chronic Hyperkalemia 3, 4 Effect of Enalapril on survival in patients with reduced left ventricular ejection fractions and congestive heart failure. failure receiving a sub-optimal dose of RAASi therapy. Blocking the RAAS at different levels: an update on the use of the direct renin inhibitors alone and in combination. A second study showed similar results for patients with stage 3-4 CKD, HF and diabetes and remarkably, mortality rates were almost comparable for patients who received reduced doses and those who discontinued. Target Audience and Goal Statement. Patients will participate in the study for approximately 16 to 18 weeks in total, depending on the duration of the screening period. The increasing longevity of humans results in a higher number of elderly patients’ presenting with multiple chronic diseases such as hypertension, diabetes, and chronic kidney disease (CKD). ACE inhibitors and ARBs are commonly used in the treatment of patients with hypertension, heart failure with reduced ejection fraction, certain types of chronic kidney disease, and patients who have suffered a myocardial infarction. These increased risks of mortality are similar for all types of RAASi. Safety. In: Post TW, ed. POINTER: While the RASI method is an integral part These adverse events comprised mainly persistent and consistent hyperkalaemia and/or worsening renal function. heart failure with reduced ejection fraction, Heart failure with reduced ejection fraction, http://care.diabetesjournals.org/content/suppl/2015/12/21/39.Supplement_1.DC2/2016-Standards-of-Care.pdf, https://www.uptodate.com/contents/renin-angiotensin-system-inhibition-in-the-treatment-of-hypertension, http://www.cvphysiology.com/Blood%20Pressure/BP015, https://www.uptodate.com/contents/aliskiren-drug-information, https://www.uptodate.com/contents/angiotensin-converting-enzyme-inhibitors-and-receptor-blockers-in-acute-myocardial-infarction-clinical-trials, https://www.uptodate.com/contents/major-side-effects-of-angiotensin-converting-enzyme-inhibitors-and-angiotensin-ii-receptor-blockers, https://www.uptodate.com/contents/angiotensin-converting-enzyme-inhibitors-and-receptor-blockers-in-pregnancy, https://www2.kidney.org/professionals/kdoqi/guidelines_bp/guide_11.htm, Drug interactions (see “Interactions” below). Franzosi MG, Santoro E, Zuanetti G, et al. 2015 Jun;349(6):510-5, 5. 2015;17:1032-1041, 7. The first meta-analysis identified 33 randomized controlled trials with 68,405 patients, and reported that dual RAASi therapy was associated with a 55% higher relative risk of … In fact, these diseases are by definition mostly asymptomatic. Polónia J. Interaction of antihypertensive drugs with anti-inflammatory drugs. 2007;167:1930-1936, 14. Direct renin inhibitors may be considered in hypertensive patients if ACE inhibitors or ARBs are not well tolerated; however, they should never be used in combination with other RAAS inhibitors. - J Am Coll Cardiol 2020, 5' education - Oct. 7, 2020 - Aernoud Fiolet, MD and prof. Jan Hein Cornel, MD, PhD, 10' education - Oct. 20, 2020 - Prof. Richard Hobbs, MD, 5' education - Jan. 15, 2020 - Thomas Gaziano, MD, Literature - Nov. 4, 2019 - Alexander M et al, - BMJ 2019, Literature - Dec. 15, 2020 - Castañer O, et al. - JAMA. Normally, angiotensin II constricts efferent vessels and thereby increases the GFR. Aliskiren: Drug Information. He showed that RAASi are frequently omitted or discontinued in clinical practice, although HF guidelines strongly recommend the use of RAASi for several indications. He showed that RAASi are frequently omitted or discontinued in clinical practice, although HF guidelines strongly recommend the use of RAASi for several indications. Renin-Angiotensin System Inhibition in the Treatment of Hypertension. Online-CME - This course consists of 3 parts. 2020. Reported percentages of RAASi therapy (single or dual) discontinuation due to hyperkalemia from randomized trials of various patient groups (e.g. Renin-angiotensin-aldosterone system inhibitors (RAASi) are the cornerstone of treatment of heart failure with reduced ejection fraction (HFrEF). 10. 11. Literature - Sep. 7, 2020 - Mehta A et al., - J Am Coll Cardiol. For a vast majority of the HFpEF patients, a RAASi‐based therapy is used. The effect of combination treatment with aliskiren and blockers of the renin-angiotensin system on hyperkalaemia and acute kidney injury: systematic review and meta-analysis. Raebel MA, et al., Pharmacoepidemiology and drug safety 2007;16:55-64. 2014;7:51-58, 9. Renin–angiotensin–aldosterone system inhibitors (RAASi) are now a standard treatment in most patients with cardiovascular disease, especially in those with heart failure (HF). Yusuf S, Pitt B, Davis CE, Hood WB, Cohn JN. The benefits of RAAS Inhibition Heart failure and CKD patients treated at guideline target doses of RAAS inhibition consistently have better clinical outcomes than patients who are treated with lower doses or who discontinue treatment1-13 Potassium levels quickly rise after induction of RAASi, but the risk of hyperkalaemia is low if you monitor potassium properly. Shirazian S, et al., Am J Med Sci. Roett MA, Liegl S, Jabbarpour Y. 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