Which serum levels should be monitored in chronic kidney disease (CKD) treated with ACE inhibitor and ARB antihypertensive medications?

Updated: Jul 21, 2021
  • Author: Pradeep Arora, MD; Chief Editor: Vecihi Batuman, MD, FASN  more...
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Use ACEIs or ARBs as tolerated, with close monitoring for renal deterioration and for hyperkalemia. With every dose change, serum creatinine levels need to be monitored. If serum creatinine levels increase more than 30% from baseline after adding RAS blockers, RAS blockers should be stopped. Avoid these agents in patients with advanced renal failure, bilateral renal artery stenosis, or renal artery stenosis in a solitary kidney.

The time of day at which patients take antihypertensive medications can affect circadian patterns of blood pressure, and this may translate into an effect on clinical outcome. Hermida et al reported, after a median follow-up of 5.4 years, that hypertensive patients with CKD who took at least 1 of their antihypertensive medications at bedtime had an adjusted risk for total cardiovascular events that was approximately one third that of patients who took all of their medications upon awakening. [66]

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