Blockade of the renin-angiotensin-aldosterone system (RAAS) is a mainstay of therapy for proteinuric kidney disease due to effects on blood pressure, proteinuria, and overall cardiovascular risk. In this case series, we highlight one of the rare but serious side effects of the most commonly used RAAS blocking drugs, angiotensin converting enzyme inhibitors (ACE-Is) and angiotensin receptor blockers (ARBs): a severe anemia due to impaired erythropoiesis. The four patients presented here were switched to a mineralocorticoid receptor blocker (MRB) that targets aldosterone without any inhibition of angiotensin II, and resulting in significant rebounds back to baseline hemoglobin levels. Furthermore, all patients had optimal blood pressure control and proteinuria reductions. These data support the use of aldosterone blocking agents in kidney disease patients with anemia secondary to ACE-Is or ARB. Presumably, any patient-regardless of kidney status-for whom RAAS blockade is indicated (e.g., diabetic patients or patients with congestive heart failure) should be switched to MRB therapy if significant anemia develops after starting an ACE-Is or ARB.
- Mineralocorticoid receptor blocker
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