This site is intended for healthcare professionals

Go to /sign-in page

You can view 5 more pages before signing in

Practicalities of treating with ACE inhibitors (or ARBs) in chronic kidney disease (CKD)

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

Authoring team

Practicalities of treatment with ACE inhibitors/ARBs

NICE suggest that (1,2):

  • in people with CKD
    • measure serum potassium concentrations, estimate the GFR before starting ACE inhibitor/ARB therapy
    • repeat these measurements between 1 and 2 weeks after starting ACE inhibitor/ARB therapy and after each dose increase
  • ACE inhibitor/ARB therapy should not normally be started if the pretreatment serum potassium concentration is significantly above the normal reference range (typically more than 5.0 mmol/litre)
  • when hyperkalaemia precludes the use of ACE inhibitors/ARBs, assessment, investigation and treatment of other factors known to promote hyperkalaemia should be undertaken and the serum potassium concentration rechecked
  • concurrent prescription of drugs known to promote hyperkalaemia is not a contraindication to the use of ACE inhibitors/ARBs
    • however clinicians must be aware that more frequent monitoring of serum potassium concentration may be required
  • stop ACE inhibitor/ARB therapy if the serum potassium concentration rises to 6.0 mmol/litre or more and other drugs known to promote hyperkalaemia have been discontinued
  • following the introduction or dose increase of ACE inhibitor/ARB, do not modify the dose if either the GFR decrease from pretreatment baseline is less than 25% or the plasma creatinine increase from baseline is less than 30%
  • if there is a fall in eGFR or rise in plasma creatinine after starting or increasing the dose of ACE inhibitor/ARB, but it is less than 25% (eGFR) or 30% (serum creatinine) of baseline, the test should be repeated in a further 1-2 weeks. Do not modify the ACE inhibitor/ARB dose if the change in eGFR is less than 25% or the change in plasma creatinine is less than 30%
  • if the change in eGFR is 25% or more or the change in plasma creatinine is 30% or more:
    • investigate other causes of a deterioration in renal function such as volume depletion or concurrent medication (for example, NSAIDs)
    • if no other cause for the deterioration in renal function is found, stop the ACE inhibitor/ARB therapy or reduce the dose to a previously tolerated lower dose, and add an alternative antihypertensive medication if required
  • where indicated, the use of ACE inhibitors/ARBs should not be influenced by a person's age as there is no evidence that their appropriate use in older people is associated with a greater risk of adverse effects

Reference:


Related pages

Create an account to add page annotations

Add information to this page that would be handy to have on hand during a consultation, such as a web address or phone number. This information will always be displayed when you visit this page