Initiating renin-angiotensin system inhibitors in chronic kidney disease.

Chronic kidney disease (CKD) is a heterogeneous group of disorders characterised by abnormalities in kidney structure or function, present for at least 3 months. Renin-angiotensin system (RAS) inhibitors are established treatments in the management of CKD, reducing the risk of adverse kidney and cardiovascular events. Despite an extensive evidence base and decades of clinical experience, they remain underused, underdosed and frequently discontinued due to concerns about changes in kidney function and hyperkalaemia. In this article, we provide an overview of initiating RAS inhibitors in adults with CKD, highlight current guideline recommendations and offer a practical approach to dealing with the challenges associated with their use.