use of ACEi in chronic renal failure patients

[ykw]

can anybody tell the details on the use of ACEi to treat HPT in renal failure patients (eg. when is its use beneficial, when to terminate treatment etc.)? if possible, can the reference be stated? thanks.

[admin]

Originally Posted by ykw

can anybody tell the details on the use of ACEi to treat HPT in renal failure patients (eg. when is its use beneficial, when to terminate treatment etc.)? if possible, can the reference be stated? thanks.

Are you trying to get us to do your homework for you????

[ykw]

certainly makes me upset to see such commend. i had done reading on it and want to confirm its usage. JNC VII gulideline stated ACEi use in controlling HPT in the compelling indication of chronic renal failure. however, ACEi has harmful effects towards the kidney. the practice sometimes is that when the patient's renal function further deterioated or approaching end stage, doctors will stop ACEi or not use ACEi on CRF patients. is it that: should creatinine clearance decreases 20-30% or hyperkalemia develop, treatment with ACEi is to be stopped? thanks

[admin]

Sorry, didn't mean to upset you..........

[ykw]

it's ok

[xiongliang0]

It seems that ACEI such as Captopril is able to reduce the protein in the urine.

[pharout]

ACE inhibitors are used in CRF pts. The important question(s) to ask are: 1) what is the extent of the chronic renal failure (i.e. what stage are they?) 2) do they have other compelling indications for an ACE (i.e. diabetes mellitus or coronary artery disease/LVD, microalbuminuria). I think the general consensus by our nephrology dept is that in most cases the benefit outweighs the risk. You probably do not want to start an ACE in someone who's SCr is >2.0. All ACEs or ARBs can potentially increase the SCr when started or titrated and this may persist for a couple of months. A 30% increase or less is considered clinically acceptable. Beyond this, stop the ACE/ARB. If the pt also has proteinuria, there is an abundance of evidence to support using these to prevent progression. If the pt has CRF w/o HTN (which is almost never the case), you can start a very low dose ACE for the renal protective benefit. The other concern with renal dysfunction would, of course, be the potential for hyperkalemia as well as above reason. So this would need to be monitored. If a pt is started on this and the SCr elevates markedly (i.e. above 30%), one would have to rule out renal artery stenosis.