RAASi therapy made practical: A unified call to action and a ready-to-use clinical toolkit
“Optimization of renin-angiotensin-aldosterone inhibitor therapies for evidence-based indications: A call to action from the cardio-kidney community,” a new joint commentary led by the ISN and partnering organizations, has been published in Kidney International Reports®, the American Journal of Preventive Cardiology, and ESC Heart Failure.
Although essential for managing chronic kidney disease, heart failure, and hypertension, RAASi therapies are often reduced or discontinued due to safety concerns, potentially worsening long-term outcomes. This commentary brings together leading voices from the cardio-kidney field to review current evidence on the risks and benefits of RAASi therapy. It offers practical strategies for clinicians managing patients with overlapping kidney and cardiovascular conditions, focusing on maintaining RAASi treatment where possible despite common challenges like hyperkalemia and acute kidney injury.
The commentary also works to introduce a multi-stakeholder initiative previously launched under the ISN-led Cardio-Kidney-Metabolic (CKM) Initiative to support the implementation of RAASi therapy. The ISN collaborated on this practical, five-part educational and clinical toolkit alongside the American Society for Preventive Cardiology, Kidney Disease: Improving Global Outcomes, and the Renal Physicians Association.
The toolkit addresses common barriers to guideline implementation, such as managing hyperkalemia, monitoring kidney function, providing dietary guidance, and enhancing clinician-patient communication. Designed for real-world use, these tools support a patient-centered approach and may be easily integrated into everyday clinical practice worldwide.
