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Use of ACE Inhibitors or ARBs

Angiotensin converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs) have been shown to slow the progression of kidney disease and reduce the risk of ESRD by blockade of the renin-angiotensin system (RAS) in diabetic and non-diabetic patients. Their use in patients with kidney disease has been widely encouraged.

Both ACE inhibitors and ARBs are routinely and safely in patients with kidney disease, but they have several potential side effects which deserve mention. First, hyperkalemia, caused by decreased urinary potassium excretion, is most commonly seen in patients with diabetes and in those with impaired renal function. Second, development of a dry cough may be seen with the use of ACE inhibitors, but is much less common with the use of ARBs. Third, acute kidney injury (AKI) may be seen with the use of ACE inhibitors or ARBs. This complication is typically a modest reduction in renal function, but can become severe in the setting of dehydration. Last, angioedema is a rare, but serious side effect of ACE inhibitors, and has been less frequently observed with ARBs. Notably, the use of both ACE inhibitors and ARBs is contraindicated in pregnancy.

Consideration should be made in individual cases as to whether a trial of an ARB may be worthwhile in an individual intolerant to an ACE inhibitor. When prescribing ACE inhibitors or ARBs, the provider should incorporate clinical and laboratory monitoring for the development of any potential complications.

Palmer BF.Managing hyperkalemia caused by inhibitors of the renin-angiotensin-aldosterone system.N Engl J Med. 2004 351(6):585-92.

Weir MR, Rolfe M. Potassium homeostasis and renin-angiotensin-aldosterone system inhibitors. Clin J Am Soc Nephrol. 2010 5(3):531-48.

Last Updated - May 08 2017 15:25:50.

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