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