(CKD) is increasing

in prevalence

in the United

States. Therapies

that can retard the progression of

CKD are needed to prevent the morbidity

and mortality associated with

reduced renal function. Although

multiple studies published in the

past 10 years have supported the

combination use of angiotensinconverting

enzyme (ACE) inhibitors

and angiotensin receptor blockers

(ARBs) to decrease proteinuria

and delay disease progression, it is

our position that combinations of

ACE inhibitors and ARBs should be

used with great caution in patients

with CKD. We do not dispute that

ACE inhibitors or ARBs used as

monotherapy can decrease proteinuria

and retard progression of renal

disease. However, in combination,

the risks of adverse effects, including

hyperkalemia, hypotension, and

worsening renal failure, could outweigh

the purported benefits of dual

blockade. Until more studies are

conducted on the safety of dual renin-

angiotensin blockade on the average

patient in the community who

has CKD, the simultaneous use of

ACE inhibitors and ARBs should be

discouraged in primary care.