How Should We Modify Recommended Renin–Angiotensin–Aldosterone System Inhibition When Facing the Cardiorenal Syndrome?

Introduction

In the advent of the characterization of the cardiorenal syndrome,¹ nephrologists and cardiologists alike frequently toil with the conceptualization of the balance between cardiac and kidney function. This is particularly pertinent in the setting of newly diagnosed left ventricular failure (LVF) in patients with pre-existing chronic kidney disease (CKD), for example, post–myocardial infarction or nonischemic cardiomyopathy. Another common dilemma is the patient with progressive deterioration of both heart and kidney function leading to refractory congestive symptoms despite recurrent heart failure hospitalizations.

Renin–angiotensin–aldosterone system (RAAS) blockade with angiotensin-converting enzyme inhibitors² or mineralocorticoid receptor antagonists³ is associated with reduced mortality in LVF. …