Abstract
Non-diabetic chronic kidney disease (ND-CKD) complicated by resistant hypertension remains a high-risk phenotype even when renin–angiotensin system blockade is optimized. This review synthesizes contemporary evidence for cardio-renal protection beyond traditional renin-angiotensin-aldosterone system inhibition (RAASi), with emphasis on mechanisms, clinical trial data, and pragmatic sequencing. Sodium–glucose cotransporter 2 inhibitors provide hemodynamic and tubular benefits that translate into renal and heart failure risk reduction in many patients with ND-CKD. Non-steroidal mineralocorticoid receptor antagonism (MRA) like finerenone targets inflammatory and fibrotic signaling and may add incremental benefit when potassium is proactively managed. The GLP-1 receptor agonists offer cardiometabolic advantages with emerging kidney signals, particularly in patients with obesity and high cardiovascular risk. Modern potassium binders can preserve RAASi/MRA intensity, and device-based blood pressure strategies (including renal denervation) may be considered in carefully selected resistant hypertension. We propose a stepwise implementation framework to maximize efficacy while minimizing adverse events through structured monitoring and multidisciplinary care.
Article Type
Review
First Page
1277
Last Page
1284
Recommended Citation
Alrashidi, Fahad S.
(2026)
"Emerging Strategies for Cardio-Renal Protection Beyond RAAS Blockade: Emphasis on Non-diabetic CKD and Resistant Hypertension,"
Saudi Medical Journal: Vol. 47:
Iss.
8, Article 4.
DOI: https://doi.org/10.15537/1658-3175.8819