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Falling eGFR (rising creatinine) with ACEi / ARB

When using ACEIs or ARBs check serum creatinine and potassium

  • before starting medication
  • two weeks after starting, and after subsequent increases in dose.
  • a small rise in creatinine is common after starting ACEi or ARB

If creatinine increase of >20% or fall in eGFR of >15%

  • Repeat creatinine, check potassium, and consider referral

If Hyperkalaemia present (serum K 5.5 - 6.5 mmol/l)

  • stop relevant drugs, eg. NSAIDs and potassium-retaining diuretics
  • check diet and proprietary treatments, eg. LoSalt (high potassium) and repeat potassium test.

If hyperkalaemia on repeat test (serum K > 6.5mmol/l) - urgent telephone call or admission.

If hyperkalaemia persists the ACE or ARB should be stopped.

If patients become dehydrated due to vomiting or diarrhoea, then often wise to stop ACEi/ARB temporarily to reduce risk of Acute Kidney Injury and hyperkalaemia