Current Opinion in Nephrology and Hypertension最新文献

Lessons from the catastrophic floods in southern Brazil: geographic and environmental factors, vulnerabilities, and the resilience of nephrology services during natural disasters. 巴西南部特大洪水的教训：地理和环境因素、脆弱性和自然灾害期间肾脏病服务的复原力

IF 2.4 3区医学

Current Opinion in Nephrology and Hypertension Pub Date : 2025-11-01 Epub Date: 2025-09-12 DOI: 10.1097/MNH.0000000000001111

Dirceu Reis Silva, Lucas Gobetti da Luz, José A Moura-Neto

{"title":"Lessons from the catastrophic floods in southern Brazil: geographic and environmental factors, vulnerabilities, and the resilience of nephrology services during natural disasters.","authors":"Dirceu Reis Silva, Lucas Gobetti da Luz, José A Moura-Neto","doi":"10.1097/MNH.0000000000001111","DOIUrl":"10.1097/MNH.0000000000001111","url":null,"abstract":"Purpose of review: In April and May of 2024, the state of Rio Grande do Sul in southern Brazil faced one of the most devastating natural disasters in its history. Torrential rains caused catastrophic flooding, affecting over 2.4 million people and damaging critical infrastructure. Among the most vulnerable were individuals with chronic kidney disease, particularly those dependent on dialysis or immunosuppressive therapy following kidney transplantation. This narrative report describes the impact of the floods on nephrology services, highlights systemic vulnerabilities, and outlines the responses by the Brazilian Society of Nephrology, healthcare providers, government authorities and other stakeholders.Recent findings: Drawing on field reports and institutional data, the article details breakdowns in transportation, communication, water and power supply, and the cascading challenges affecting dialysis provision. It also documents mitigation efforts, including patient relocation, resource reallocation, inter-institutional collaboration, and telemedicine deployment. Although no deaths due to lack of dialysis were reported, the crisis exposed the fragility of health service continuity in extreme events.Summary: This event underscores the urgent need to incorporate disaster preparedness into nephrology service planning. Strategies must be tailored to the specific geographic and infrastructural contexts of each region and integrated into broader public health emergency frameworks. The lessons learned offer valuable insights for strengthening healthcare system resilience in the face of climate-related disasters.","PeriodicalId":10960,"journal":{"name":"Current Opinion in Nephrology and Hypertension","volume":" ","pages":"514-520"},"PeriodicalIF":2.4,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145063759","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Continuous glucose monitoring and automated insulin delivery systems in the management of diabetes among individuals with chronic kidney disease on dialysis. 连续血糖监测和自动胰岛素输送系统在慢性肾病透析患者糖尿病管理中的应用

IF 2.4 3区医学

Current Opinion in Nephrology and Hypertension Pub Date : 2025-11-01 Epub Date: 2025-07-21 DOI: 10.1097/MNH.0000000000001106

Alexandros L Liarakos, Ashveer Randhay, Emma G Wilmot

{"title":"Continuous glucose monitoring and automated insulin delivery systems in the management of diabetes among individuals with chronic kidney disease on dialysis.","authors":"Alexandros L Liarakos, Ashveer Randhay, Emma G Wilmot","doi":"10.1097/MNH.0000000000001106","DOIUrl":"10.1097/MNH.0000000000001106","url":null,"abstract":"Purpose of review: To describe the current evidence and emerging role of continuous glucose monitoring (CGM) and automated insulin delivery (AID) systems in the management of diabetes among individuals with advanced chronic kidney disease (CKD) undergoing dialysis.Recent findings: Recent studies have shown that CGM provides accurate and clinically useful glucose data in people with advanced CKD requiring dialysis. CGM enables the detection of glycaemic variability and hypoglycaemia patterns that are often missed by traditional monitoring methods, such as capillary blood glucose testing and haemoglobin A1c. While observational studies show benefits, randomised controlled trial data are limited. Early trials and case series suggest that AID, especially fully closed-loop systems, may improve glycaemia in dialysis-dependent individuals with diabetes, though evidence is currently sparse and primarily focused on type 2 diabetes. Several ongoing and planned studies aim to address these knowledge gaps.Summary: CGM represents a valuable tool for improving glucose management and safety in people with diabetes and advanced CKD, but barriers to widespread use, such as cost, access, and healthcare provider familiarity, remain significant. AID technologies show promise but require further evaluation in this population. Future research should prioritise long-term outcomes, cost-effectiveness, and patient-reported outcomes to support the integration of these technologies into routine care for this high-risk group.","PeriodicalId":10960,"journal":{"name":"Current Opinion in Nephrology and Hypertension","volume":" ","pages":"477-282"},"PeriodicalIF":2.4,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144682194","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Do not overlook the children: the unique needs of children with kidney diseases during disasters. 不要忽视儿童：灾害期间肾病儿童的独特需求。

IF 2.4 3区医学

Current Opinion in Nephrology and Hypertension Pub Date : 2025-11-01 Epub Date: 2025-08-01 DOI: 10.1097/MNH.0000000000001108

Lale Sever, Nur Canpolat

{"title":"Do not overlook the children: the unique needs of children with kidney diseases during disasters.","authors":"Lale Sever, Nur Canpolat","doi":"10.1097/MNH.0000000000001108","DOIUrl":"10.1097/MNH.0000000000001108","url":null,"abstract":"Purpose of review: Children with kidney diseases are among the most vulnerable populations in disaster settings due to their age-specific physiological features, need for specialized care, and dependence on caregivers. This review highlights the importance of disaster preparedness tailored to pediatric kidney patients and proposes practical measures.Recent findings: Natural and man-made disasters continue to disrupt healthcare globally, often leading to poor outcomes in patients with chronic diseases. Despite international efforts, preparedness for pediatric kidney patients - including those with chronic kidney disease not on dialysis, those on hemodialysis or peritoneal dialysis, and transplant recipients - remains limited. Disasters frequently cause medication shortages, treatment interruptions, underdialysis, and increased risk of infection. Pediatric patients face unique logistical and clinical challenges, such as lack of age-appropriate dialysis supplies and trained personnel.Summary: Disaster preparedness strategies at the unit, regional, and national levels are essential to reduce risks and improve outcomes for pediatric kidney patients during disasters. These strategies must include pediatric-specific resources, trained personnel, caregiver education, and integration with broader emergency systems and official authorities. International nephrology societies and humanitarian organizations can also provide valuable support.","PeriodicalId":10960,"journal":{"name":"Current Opinion in Nephrology and Hypertension","volume":" ","pages":"543-550"},"PeriodicalIF":2.4,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144759382","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Time to integrate climate science into kidney care planning: a 'PASIGE' to a climate change mitigation and adaptation framework. 是时候将气候科学纳入肾脏护理规划：对气候变化减缓和适应框架的“PASIGE”。

IF 2.4 3区医学

Current Opinion in Nephrology and Hypertension Pub Date : 2025-11-01 Epub Date: 2025-07-23 DOI: 10.1097/MNH.0000000000001109

Shaifali Sandal, Vivekanand Jha

{"title":"Time to integrate climate science into kidney care planning: a 'PASIGE' to a climate change mitigation and adaptation framework.","authors":"Shaifali Sandal, Vivekanand Jha","doi":"10.1097/MNH.0000000000001109","DOIUrl":"10.1097/MNH.0000000000001109","url":null,"abstract":"Purpose of review: Kidney diseases affect around 850 million people globally and are a growing public health burden, with high rates of associated cardiovascular mortality and no major decline in age-standardized mortality compared to other noncommunicable diseases. Climate change is an inequitable driver of kidney diseases, and climate-related disasters can disrupt access to life-sustaining kidney replacement therapies. Conversely, the care of patients with kidney diseases contributes to greenhouse gas emissions, pollution, and generates large amounts of waste.Recent findings: Environmentally sustainable kidney care planning is pursuing kidney care practices and innovations that minimize environmental harm while remaining patient-centered and cost-effective. An adaptation and mitigation framework (a structured approach to developing adaptation strategies, policies, and measures) to guide this is lacking.Summary: We propose the 'PASIGE' framework to guide climate science integration in kidney care planning -> Prevent: approaches to prevent kidney disease, its progression to kidney failure, and complications; Adopt: sustainable lifestyle, practices and therapies; Screen: targeted population screening for early detection and identification of kidney disease; Innovate: technology, manufacturing, procurement, energy sources and transportation; Generate: sustainably powered and produced low-impact net zero waste kidney replacement therapies resilient to climate threats; and Enhance: patient engagement, care quality, and system resiliency.","PeriodicalId":10960,"journal":{"name":"Current Opinion in Nephrology and Hypertension","volume":" ","pages":"534-542"},"PeriodicalIF":2.4,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144689457","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

When the earth shakes unexpectedly: impact on nephrology services and patients. 当大地意外震动：对肾脏病服务和患者的影响。

IF 2.4 3区医学

Current Opinion in Nephrology and Hypertension Pub Date : 2025-11-01 Epub Date: 2025-08-01 DOI: 10.1097/MNH.0000000000001110

Murat Tuğcu, Z Serhan Tuğlular

{"title":"When the earth shakes unexpectedly: impact on nephrology services and patients.","authors":"Murat Tuğcu, Z Serhan Tuğlular","doi":"10.1097/MNH.0000000000001110","DOIUrl":"10.1097/MNH.0000000000001110","url":null,"abstract":"Purpose of review: This review examines the impact of earthquakes on nephrology services and patients, highlighting the urgent need for integrated disaster preparedness in renal care. With earthquakes increasing in frequency and affecting densely populated regions, the relevance of this topic to both clinical practice and policy has never been greater.Recent findings: Earthquakes disrupt dialysis infrastructure, impede access to care, and create surges in acute kidney injury (AKI) due to crush syndrome. Hemodialysis (HD) services are highly vulnerable to power, water, and transportation failures, whereas peritoneal dialysis (PD) offers greater resilience but faces hygiene and supply challenges. Special populations - pediatric patients, transplant recipients, and displaced persons - face unique vulnerabilities. Global experiences demonstrate that flexible modalities, patient education, and coordinated international responses can mitigate risks. Despite this, PD remains underutilized and disaster-specific planning is often lacking.Summary: Earthquakes expose critical weaknesses in nephrology systems but also provide lessons in resilience. Proactive strategies - including PD-first policies, interoperable patient registries, emergency kits, and mobile dialysis units - are essential to protect kidney patients during future disasters. Integrating nephrology into disaster frameworks is both a clinical imperative and a humanitarian necessity.","PeriodicalId":10960,"journal":{"name":"Current Opinion in Nephrology and Hypertension","volume":" ","pages":"509-513"},"PeriodicalIF":2.4,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144759383","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Moving beyond the syndrome: how can acute kidney injury phenotypes help? 超越症候群：急性肾损伤表型如何起作用？

IF 2.4 3区医学

Current Opinion in Nephrology and Hypertension Pub Date : 2025-11-01 Epub Date: 2025-06-12 DOI: 10.1097/MNH.0000000000001098

Jennifer Scott, Emily J See, Yvelynne P Kelly

{"title":"Moving beyond the syndrome: how can acute kidney injury phenotypes help?","authors":"Jennifer Scott, Emily J See, Yvelynne P Kelly","doi":"10.1097/MNH.0000000000001098","DOIUrl":"10.1097/MNH.0000000000001098","url":null,"abstract":"Purpose of review: The purpose of this review is to describe recent and important updates in acute kidney injury (AKI) phenotyping that help us to move beyond the clinical syndrome of AKI.Recent findings: Recent studies reinforce the utility of damage biomarker positivity in AKI classification and have found that biomarker positivity (specifically NGAL) adds prognostic information regardless of classification of the AKI according to RIFLE or KDIGO criteria, and regardless of cut-off selection methodology. Novel methodologies for identifying AKI phenotypes and subphenotypes are currently being developed and integrated subclassification approaches e.g. combining biomarker and transcriptomic approaches, have been found to be more informative than using a single approach alone to identify AKI phenotypes. Consortiums have developed in partnership between academia and industry to identify consensus endotypes for critically ill adults and children.Summary: There are prognostic and treatment benefits to AKI phenotyping and subphenotyping which allow us to provide a customized approach to AKI care. Challenges currently exist to implementation of AKI phenotyping at the bedside but ongoing projects are already seeking solutions for feasible bedside identification of subphenotypes using machine-learning or point-of-care biomarker assays. Future research in this area will focus on the ability to recognize and link endotypes, subphenotypes and phenotypes in AKI.","PeriodicalId":10960,"journal":{"name":"Current Opinion in Nephrology and Hypertension","volume":" ","pages":"491-499"},"PeriodicalIF":2.4,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144332629","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Displacement and kidney care disruption in Sudan: lessons from a fragile health crisis. 苏丹流离失所和肾脏护理中断：脆弱健康危机的教训。

IF 2.4 3区医学

Current Opinion in Nephrology and Hypertension Pub Date : 2025-11-01 Epub Date: 2025-09-25 DOI: 10.1097/MNH.0000000000001115

Dina A Abdellatif, Nihal Beshir, Mehmet S Sever

{"title":"Displacement and kidney care disruption in Sudan: lessons from a fragile health crisis.","authors":"Dina A Abdellatif, Nihal Beshir, Mehmet S Sever","doi":"10.1097/MNH.0000000000001115","DOIUrl":"10.1097/MNH.0000000000001115","url":null,"abstract":"Purpose of review: To examine the disruption of kidney care services in Sudan following the 2023 conflict, highlighting the compounded risks faced by dialysis and transplant patients during crises, and offering evidence-based strategies for future emergency preparedness.Recent findings: The conflict in Sudan exposed deep systemic weaknesses in an already under-resourced nephrology infrastructure. Hemodialysis centers were damaged or shut down, supply chains collapsed, and patient displacement became widespread. Over 70% of patients experienced treatment interruption and many died due to missed dialysis sessions or transplant rejection. Emergency responses were delayed and uncoordinated. In contrast, experience from Ukraine and Gaza disasters illustrate how registry-based evacuation and cross-border planning can save lives. Egypt's subsequent collaboration with WHO and KSrelief (King Salman Humanitarian Aid and Relief Center) offered a late but instructive model for regional support.Summary: Sudan's crisis demonstrates how kidney patients suffer disproportionately from adverse effects of disasters when health systems collapse. Displacement may become a survival tactic in the absence of formal evacuation or support plans. Embedding kidney care into disaster response-through registries, mental health support, cross-border agreements, and sustainable NCD programming-is urgently needed. Global momentum, such as WHA78's kidney resolution, must now translate into national preparedness for fragile settings.","PeriodicalId":10960,"journal":{"name":"Current Opinion in Nephrology and Hypertension","volume":" ","pages":"527-533"},"PeriodicalIF":2.4,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145079772","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Recent advances in the use of intravenous iron in cardiorenal disease: a review of efficacy and safety. 静脉注射铁治疗心肾疾病的最新进展：疗效和安全性综述

IF 2.4 3区医学

Current Opinion in Nephrology and Hypertension Pub Date : 2025-11-01 Epub Date: 2025-09-25 DOI: 10.1097/MNH.0000000000001119

Han Sean Lee, Paul R Kalra, Philip A Kalra

{"title":"Recent advances in the use of intravenous iron in cardiorenal disease: a review of efficacy and safety.","authors":"Han Sean Lee, Paul R Kalra, Philip A Kalra","doi":"10.1097/MNH.0000000000001119","DOIUrl":"https://doi.org/10.1097/MNH.0000000000001119","url":null,"abstract":"Purpose of review: Cardiorenal disease is commonly complicated by iron deficiency, which worsens clinical outcomes regardless of haemoglobin levels. This review evaluates recent evidence on intravenous iron therapy in this setting.Recent findings: Recent randomized trials demonstrate the important role of intravenous iron in improving functional status and quality of life as well as reducing hospitalizations in patients with heart failure and iron deficiency. In chronic kidney disease, intravenous iron showed potential cardiovascular benefits beyond anaemia correction and is now recommended in updated guidelines. Although historically there were concerns regarding adverse reactions, recent trial data using modern high-dose intravenous irons have demonstrated an acceptable safety profile.Summary: Intravenous iron offers clinical benefits in cardiorenal disease, supporting its expanded use even in the absence of anaemia. Broader adoption in clinical practice remains limited despite updated guidelines. Whilst safety data are generally reassuring, further studies will help define long-term safety and optimal use in non-dialysis, non-anaemic populations.","PeriodicalId":10960,"journal":{"name":"Current Opinion in Nephrology and Hypertension","volume":"34 6","pages":"551-558"},"PeriodicalIF":2.4,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145130210","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

APOL1 testing in clinical practice and opportunities for new therapies. APOL1在临床实践中的检测和新疗法的机会。

IF 2.4 3区医学

Current Opinion in Nephrology and Hypertension Pub Date : 2025-11-01 Epub Date: 2025-05-02 DOI: 10.1097/MNH.0000000000001082

Taewoo Lee, Lijun Ma, Barry I Freedman

{"title":"APOL1 testing in clinical practice and opportunities for new therapies.","authors":"Taewoo Lee, Lijun Ma, Barry I Freedman","doi":"10.1097/MNH.0000000000001082","DOIUrl":"10.1097/MNH.0000000000001082","url":null,"abstract":"Purpose of review: The spectrum of kidney diseases caused by variation in the apolipoprotein L1 ( APOL1 ) gene was identified in 2010 among patients with recent African ancestry. In the United States, inheriting two APOL1 risk variants (high-risk genotypes) markedly increases risk for solidified glomerulosclerosis, focal segmental glomerulosclerosis, collapsing glomerulopathy, lupus nephritis, and sickle cell nephropathy. Kidneys from African American deceased donors with APOL1 high-risk genotypes also fail more rapidly after transplant. One risk variant increases nephropathy risk in Africa. This review focuses on novel therapies targeting APOL1 and the changing landscape of APOL1 genotyping in patients at risk for APOL1 -mediated kidney disease (AMKD).Recent findings: Renin-angiotensin-aldosterone system blockade and sodium-glucose cotransporter 2 inhibitors slow nephropathy progression but are not curative. Medications directly targeting APOL1 mRNA and blocking APOL1 protein effects are undergoing clinical trials in AMKD, including APOL1 small molecule inhibitors, an APOL1 antisense oligonucleotide, and a Janus kinase (JAK) signaling inhibitor to reduce APOL1 expression. Early results are promising and provide hope for well tolerated and effective therapies. If successful, more patients will need to be considered for APOL1 genotyping, and our approach to diagnosing and treating chronic kidney disease in populations with recent African ancestry will change dramatically.Summary: Mechanisms of APOL1 risk variant nephrotoxicity remain unclear; nonetheless, specific therapies for AMKD show great promise and may improve understanding of disease processes. With ongoing clinical trials and the potential for effective AMKD treatments, more widespread APOL1 genotyping will likely be needed.","PeriodicalId":10960,"journal":{"name":"Current Opinion in Nephrology and Hypertension","volume":" ","pages":"500-506"},"PeriodicalIF":2.4,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143982823","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Optimizing renin-angiotensin-aldosterone inhibition in advanced chronic kidney disease: balancing benefits and risks. 优化肾素-血管紧张素-醛固酮抑制在晚期慢性肾病：平衡利益和风险。

IF 2.4 3区医学

Current Opinion in Nephrology and Hypertension Pub Date : 2025-11-01 Epub Date: 2025-04-10 DOI: 10.1097/MNH.0000000000001076

Sebastian Spencer, Sunil Bhandari

{"title":"Optimizing renin-angiotensin-aldosterone inhibition in advanced chronic kidney disease: balancing benefits and risks.","authors":"Sebastian Spencer, Sunil Bhandari","doi":"10.1097/MNH.0000000000001076","DOIUrl":"10.1097/MNH.0000000000001076","url":null,"abstract":"Purpose of review: Renin-angiotensin-aldosterone system inhibitors (RAASi), including angiotensin-converting enzyme inhibitors (ACEi) and angiotensin II receptor blockers (ARBs), are fundamental in chronic kidney disease (CKD) management, particularly in proteinuric conditions. However, their use in advanced CKD (eGFR <30 ml/min/1.73 m 2 ) remains debated because of risks of hyperkalaemia, acute kidney injury (AKI), and hypotension. This review evaluates the latest evidence, including the STOP-ACEi trial, to inform the risks and benefits of RAASi in advanced CKD.Recent findings: The STOP-ACEi trial, a multicentre randomized controlled trial (RCT), investigated RAASi discontinuation in 411 patients with advanced CKD. After 3 years, discontinuation did not slow eGFR decline or reduce mortality, while continuation was associated with a numerical trend towards lower end-stage kidney disease (ESKD) rates. Meta-analyses also indicate that ACEi may offer superior kidney protection compared to ARBs, though both lower cardiovascular risk and this difference may not be clinically significant. Combination ACEi/ARB therapy provides no additional benefits and increases adverse events, such as hyperkalaemia and hypotension. Adjunct therapies like potassium binders and sodium-glucose cotransporter-2 (SGLT2) inhibitors may enable safer RAASi use in high-risk patients.Summary: Current evidence supports RAASi continuation in most CKD patients, including those with advanced disease, unless contraindicated. Future studies should refine patient selection criteria and optimize adjunctive strategies to mitigate adverse effects.","PeriodicalId":10960,"journal":{"name":"Current Opinion in Nephrology and Hypertension","volume":" ","pages":"469-476"},"PeriodicalIF":2.4,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143987307","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0