When monitoring RAAS blockade, which population requires careful potassium monitoring?

• A. In patients with CKD and diabetes
• B. In patients with CKD
• C. In patients without CKD
• D. In patients with hyperkalemia risk but not CKD

Answer: (B)

Key concept: RAAS blockade lowers aldosterone, which reduces potassium excretion in the distal nephron. When kidney function is impaired, as in CKD, the ability to clear potassium is diminished even further. This combination makes hyperkalemia a real and potentially dangerous risk, so patients with CKD must have careful and ongoing potassium monitoring when on RAAS inhibitors.

In people without CKD, potassium handling is usually adequate, so the hyperkalemia risk is lower; diabetes alone increases long-term risk of kidney disease but doesn't by itself create the same level of need for intensive potassium monitoring as established CKD does.