Does inhibiting the RAAS with ACE ARB MRA cause hyperkalemia in patients on dialysis
Does inhibiting the renin-angiotensin aldosterone system (RAAS) with angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, and mineralocorticoid receptor antagonists (MRA) cause hyperkalemia in patients on dialysis?
End-stage kidney disease (ESKD) patients on dialysis may be oliguric or anuric and hence do not depend on kidney excretion of potassium. These patients depend on dialysis and restriction of oral intake of potassium to maintain acceptable levels. Recent evidence from small-sized studies has shown that administration of low-dose MRA provides cardioprotective effects in both hemodialysis and peritoneal dialysis patients without significantly increasing the risk of hyperkalemia. MRA may improve mortality in ESKD dialysis patients, but larger studies are needed to establish safe protocols for their use in dialysis patients.