CHRONIC RENAL DISEASE

When treatment with an ACE inhibitor or ARB is initiated,the creatinine and potassium levels can rise

• If the acute rise in creatinine is less than 30% above the baseline level and stabilises within two months, the medication should be continued. People whose creatinine rises are most likely to achieve the greatest benefit in terms of kidney protection
• If the rise in creatinine is greater than 30% above baseline value, the medication should be stopped and the person investigated for bilateral renal artery stenosis
• If the serum potassium concentration is greater than 6 mmol/L despite dose reduction, diuretic therapy and dietary potassium restriction, then the medication (including spironolactone) should also be stopped

Source: www.kidney.org.au Nov 2007