Kidneys glomerular filtration/hyperkalemia

ACEIs and angiotensin II receptor blockers (ARBs) traditionally have been avoided in kidney transplant recipients because of the potential for hyperkalemia and decreased glomerular filtration rate. ACEIs and ARBs are now considered to be an equivalent alternative to calcium channel blockers for the treatment of hypertension in aU transplant recipients. When ACEIs or ARBs are used in patients after transplantation, serum creatinine and potassium levels should be mon-... 

Electrolyte balance Concern about the risk of hyperkalemia associated with ACE inhibitors in patients with chronic kidney disease probably inhibits their use in such patients despite the beneficial effects of ACE inhibitors on progression of chronic kidney disease. In 1094 non-diabetic African-American adults with hypertensive chronic kidney disease, hyperkalemia was associated with increasing age, baseline protein excretion, glomerular filtration rate (GFR), and baseline potassium concentrations. Use of a potassium-wasting diuretic reduced the risk of hyperkalemia [36 ]. 

Using the African American Study of Kidney Disease and Hypertension (AASK) database, non-diabetic adults were randomly assigned to ACE inhibitors, beta adrenoceptor antagonists, or calcium channel blockers [42 ]. Hjq)erkalemia was associated with a reduced glomerular filtration rate (below 41 ml/minute/1.73 m ). Hjq)erkalemia was also significantly more common with ACE inhibitors. The use of a potassium-wasting diuretic was associated with a 59% reduction in the risk of hyperkalemia. 

ACE inhibitors and ARBs slow the progression of diabetic kidney disease. A trial that was reported in 2000 confirmed that even nonmicroalbuminuric type 2 diabetic patients should be managed with ACE inhibitors or ARBs to prevent cardiovascular events.In addition to lowering systemic blood pressure, such patients also have lowered glomerular capillary blood pressure and protein filtration,ACE inhibitors and ARBs also reduce All-medi-ated effects on glomerular permeability and cell proliferation and fibrosis and should be incorporated into the treatment schedules of all patients with type 2 diabetes and those with type 1 diabetes and microalbuminuria, ACE inhibitors may exacerbate hyperkalemia in patients with advanced CKD and/or hyporeninemic hypoaldosteronism. In older patients with renal artery stenosis, they may cause a rapid decline in kidney function. Pooled data from large clinical trials indicated above show that only 1.5% of patients treated with ACE inhibitors or ARBs were withdrawn from trials because of hyperkalemia, and no deaths were reported as a consequence of hyperkalemia. ... 

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