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ACE inhibitor initiation in CKD — ESENeph MCQ

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EasyChronic Kidney DiseaseACE inhibitor initiation in CKDESENeph

A 70-year-old man with CKD G3b starts an ACE inhibitor for albuminuric CKD. Two weeks later creatinine has risen from 142 to 174 micromol/L and potassium is 5.2 mmol/L. Blood pressure has improved from 158/88 to 136/78 mmHg and he feels well. What is the most appropriate management?

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Correct answer: D — Continue treatment and repeat renal function soon

A creatinine rise of about 23% after starting ACE inhibition is usually acceptable if potassium is manageable and the patient is stable. Stopping permanently would lose renal and cardiovascular benefit. Intravenous calcium is reserved for severe hyperkalaemia with ECG changes, not potassium 5.2 mmol/L. The pearl is that a creatinine rise above 30% or marked hyperkalaemia should prompt review for renal artery stenosis, hypovolaemia, NSAIDs or over-diuresis.

Reference: NICE NG203; BNF