Premium
Use of renin angiotensin system inhibitors in patients with chronic kidney disease
Author(s) -
Adam W. R.,
Wright J. R.
Publication year - 2016
Publication title -
internal medicine journal
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.596
H-Index - 70
eISSN - 1445-5994
pISSN - 1444-0903
DOI - 10.1111/imj.13060
Subject(s) - medicine , renal function , kidney disease , proteinuria , urology , hyperkalemia , renin–angiotensin system , kidney , cardiology , blood pressure
Current guidelines recommend renin angiotensin system inhibitors ( RASI ) as key components of treatment of hypertension in patients with chronic kidney disease ( CKD ), because of their effect on reducing the future rate of loss of glomerular filtration rate ( GFR ). A common risk of RASI in CKD is a haemodynamically mediated, and reversible, fall in GFR of varying severity and duration, any time after commencement of the Inhibitors. A benefit of the acute reduction in filtration rate with RASI may be a reduction in the future rate of loss in GFR : the greatest benefit likely to be in those patients with a greater rate of loss of GFR prior to, and a lesser acute loss of GFR after, introduction of RASI ; and in those patients with significant proteinuria. An acute loss of GFR of >25% following the introduction of RASI is an indication to cease the RASI . An acute loss of GFR < 25% requires consideration of the likely risks of the lower GFR and benefits of any future reduced rate of loss of GFR . A fall in GFR in patients while on RASI is usually associated with a remediable cause. When the cause for the fall in GFR is not revealed, and the fall is less than 25%, hopeful expectancy is recommended. Hyperkalaemia in patients with CKD on RASI is more common with more severe disease, potassium retaining diuretics and hypoaldosteronism. Treatment should be modified to maintain a plasma potassium <6 mmol/L.