RASi Potassium Threshold KDIGO — ESENeph MCQ
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Correct answer: B — Use a potassium binder to preserve ramipril
KDIGO emphasizes treating hyperkalaemia in preference to de-escalating proven renin–angiotensin blockade. Patiromer or sodium zirconium cyclosilicate can enable continuation in suitable patients, with monitoring and attention to local criteria. Dose reduction or cessation is reserved for uncontrolled hyperkalaemia despite treatment, symptomatic hypotension or other intolerance—not a universal single potassium cutoff. The competing options do not fit the renal phenotype, temporal relationship, treatment threshold or safety constraint described. Management still requires confirmation of current medicines, renal trajectory and relevant contraindications, followed by timely biochemical and clinical reassessment. Escalate urgently if life-threatening electrolyte disturbance, respiratory compromise, shock, neurological deterioration or a dialysis indication develops.
Reference: KDIGO 2024 Clinical Practice Guideline for CKD. https://kdigo.org/wp-content/uploads/2024/03/KDIGO-2024-CKD-Guideline.pdf; UK Kidney Association Hyperkalaemia Guideline. https://guidelines.ukkidney.org/hyperkalaemia/