Editorial Serum Potassium in Dual Renin-Angiotensin-Aldosterone System Blockade

Treatment with angiotensin-converting enzyme inhib-itors (ACEIs) or angiotensin receptor blockers (ARBs) slows the progression of proteinuric diabetic kidney disease (1–3).However, the risk of progression remains high despite these medications. In the Reduction of Endpoints in NIDDM with the Angiotensin II Antag-onist Losartan trial and the Irbesartan Diabetic Ne-phropathy Trial, the treatment-induced decrease in albuminuria correlated with overall benefit in terms of risk of CKD progression, and individuals with re-sidual albuminuria despite ARB treatment were at higher risk for progression (1,3). These observations led to the hypothesis that greater reductions in al-buminuria with more intensive renin-angiotensin-aldosterone system (RAAS) blockade would furthe