There is an alarming rise of the prevalence of patients with chronic kidney disease (CKD) and diabetes mellitus globally, which is associated with excessive morbidity and mortality.

RAAS blockade with angiotensin-converting enzyme inhibitors (ACEi) or angiotensin receptor blockers (ARB) can dampen but not halt the progression of CKD.

We hypothesize that mineralocorticoid receptor antagonists (MRA) on top of conventional RAAS blockade change the angiotensin pattern resulting in cardio- and renoprotective effects.

Eplerenone on top of ACEi upregulates plasma renin, Ang I and aldosterone concentrations, while Ang II remains suppressed.

Eplerenone add on to ACEi further increases plasma Ang-(1–7) levels.

Potential beneficial effects of alternative RAAS activation should be considered for personalised renoprotective therapies in patients with CKD and diabetes mellitus.