Roopa Shah1, Matthew A Sparks1,2. 1. Division of Nephrology, Department of Medicine, Duke University School of Medicine. 2. Renal Section, Durham VA Medical Center, Durham, North Carolina, USA.
Abstract
PURPOSE OF REVIEW: To present the available data on the risks and benefits for ACEi/ARB usage in patients with advanced CKD. RECENT FINDINGS: It has been well established that ACEi/ARB use is beneficial in patients with mild-to-moderate CKD, especially in patients with proteinuria. The majority of available data includes patients with diabetes mellitus. However, data in individuals with advanced CKD are limited. Additionally, data available for this subset of patients is conflicting and the definition of advanced CKD varies across clinical trials. SUMMARY: On the basis of our literature review, evidence suggests continuing ACEi/ARB therapy in patients with advanced CKD (eGFR less than 15 ml/min/1.73 m) unless hyperkalemia ensues unresponsive to therapy, hypotension develops or have unusually rapid worsening of eGFR (not usual progressive decline). These patients should be monitored closely. There is not enough data to support starting ACEi/ARBs de novo in patients with advanced CKD (eGFR less than 15 ml/min/1.73 m). If RAS blockade is started de novo in this subgroup, we recommend close monitoring.
PURPOSE OF REVIEW: To present the available data on the risks and benefits for ACEi/ARB usage in patients with advanced CKD. RECENT FINDINGS: It has been well established that ACEi/ARB use is beneficial in patients with mild-to-moderate CKD, especially in patients with proteinuria. The majority of available data includes patients with diabetes mellitus. However, data in individuals with advanced CKD are limited. Additionally, data available for this subset of patients is conflicting and the definition of advanced CKD varies across clinical trials. SUMMARY: On the basis of our literature review, evidence suggests continuing ACEi/ARB therapy in patients with advanced CKD (eGFR less than 15 ml/min/1.73 m) unless hyperkalemia ensues unresponsive to therapy, hypotension develops or have unusually rapid worsening of eGFR (not usual progressive decline). These patients should be monitored closely. There is not enough data to support starting ACEi/ARBs de novo in patients with advanced CKD (eGFR less than 15 ml/min/1.73 m). If RAS blockade is started de novo in this subgroup, we recommend close monitoring.
Authors: Carl P Walther; Wolfgang C Winkelmayer; Peter A Richardson; Salim S Virani; Sankar D Navaneethan Journal: Nephrol Dial Transplant Date: 2021-09-27 Impact factor: 7.186