What is your approach to GDMT uptitration (particularly dosing for ARBs/ARNIs/MRA) if there is further evidence of renal dysfunction, especially in situations with worsening AKI on CKD?    

Titration of RAAS inhibitors in the setting of AKI on CKD is challenging. First, look at the patient: if they have an increase in Cr after an increase in the RAAS inhibitor but no/stable HF symptoms and appear euvolemic on examination, then I will decrease diuretic therapy and see if the Cr improves...

I completely agree with Dr. @Kittleson's approach. Correlating the data with blood pressure and volemia is key to making the decision. It's important to point out that defaulting to reduce the doses may harm the patient in the long term as these patients can easily be labeled "intolerant" or at max ...

I think the approach by Dr. @Michelle M. Kittleson is great. Additionally, you must consider the role of cardiac output and venous congestion when assessing the true renal congestive pathway and RAAS effect. Patient Stevenson Profiles are important to understand if the worsening renal function resul...