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Renin-angiotensin system inhibition in advanced chronic kidney disease: how low can the kidney function go?
- Source :
-
Current opinion in nephrology and hypertension [Curr Opin Nephrol Hypertens] 2019 Mar; Vol. 28 (2), pp. 171-177. - Publication Year :
- 2019
-
Abstract
- Purpose of Review: To present the available data on the risks and benefits for ACEi/ARB usage in patients with advanced CKD.<br />Recent Findings: It has been well established that ACEi/ARB use is beneficial in patients with mild-to-moderate CKD, especially in patients with proteinuria. The majority of available data includes patients with diabetes mellitus. However, data in individuals with advanced CKD are limited. Additionally, data available for this subset of patients is conflicting and the definition of advanced CKD varies across clinical trials.<br />Summary: On the basis of our literature review, evidence suggests continuing ACEi/ARB therapy in patients with advanced CKD (eGFR less than 15 ml/min/1.73 m) unless hyperkalemia ensues unresponsive to therapy, hypotension develops or have unusually rapid worsening of eGFR (not usual progressive decline). These patients should be monitored closely. There is not enough data to support starting ACEi/ARBs de novo in patients with advanced CKD (eGFR less than 15 ml/min/1.73 m). If RAS blockade is started de novo in this subgroup, we recommend close monitoring.
- Subjects :
- Angiotensin Receptor Antagonists adverse effects
Angiotensin-Converting Enzyme Inhibitors adverse effects
Antihypertensive Agents adverse effects
Humans
Hyperkalemia chemically induced
Hypotension chemically induced
Kidney Failure, Chronic complications
Proteinuria etiology
Renin-Angiotensin System
Risk Assessment
Angiotensin Receptor Antagonists therapeutic use
Angiotensin-Converting Enzyme Inhibitors therapeutic use
Antihypertensive Agents therapeutic use
Glomerular Filtration Rate
Kidney Failure, Chronic physiopathology
Subjects
Details
- Language :
- English
- ISSN :
- 1473-6543
- Volume :
- 28
- Issue :
- 2
- Database :
- MEDLINE
- Journal :
- Current opinion in nephrology and hypertension
- Publication Type :
- Academic Journal
- Accession number :
- 30585852
- Full Text :
- https://doi.org/10.1097/MNH.0000000000000484