Safety of ACE inhibitor therapies in patients with chronic kidney disease

  title={Safety of ACE inhibitor therapies in patients with chronic kidney disease},
  author={Grigory Sidorenkov and Gerjan J Navis},
  journal={Expert Opinion on Drug Safety},
  pages={1383 - 1395}
Introduction: ACE inhibitors are first-line therapy in patients with chronic kidney disease (CKD). The main adverse effects of ACE inhibitors are hypotension, renal function impairment and hyperkalemia. Areas covered: This paper reviews evidence from clinical studies regarding adverse effects of ACE inhibitors in patients with CKD. The safety aspects of ACE inhibitors are discussed in relation to their pharmacological action, drug–drug interactions, drug–diet interaction, precautions needed in… 
Adverse safety events in patients with Chronic Kidney Disease (CKD)
Better outcomes in CKD may be achieved by alerting care providers to the special care needs of kidney patients and encouraging patients to self-manage their disease with the decision support of multidisciplinary patient care teams.
Tolerability of Antihypertensive Medications in Older Adults
Antihypertensive therapy in typical settings in older adults is discussed; they include hypertension in association with impaired cognition, depression, diabetes, sexual dysfunction, and falls, and the rationale for nonadherence to medication is reviewed.
Low protein diets in patients with chronic kidney disease: a bridge between mainstream and complementary-alternative medicines?
In this narrative review, it is discussed how the lessons of complementary alternative medicines (CAMs) can be useful for the implementation and study of low-protein diets in CKD.
Utilisation and Tolerability of Aliskiren in the Primary Care Setting in England
The results of this postmarketing prescription‐event monitoring study should be used in conjunction with other clinical and pharmacoepidemiologic studies to optimize the safe prescribing of aliskiren.
The high percentage of dose discrepancy indicates the need for monitoring of drug use especially in the aspect of continuous dosing to reduce the incidence of drug related problems and slow the progression of the disease.
Prognostic Impact of Angiotensin-Converting Enzyme Inhibitors and Receptor Blockers on Recurrent Ventricular Tachyarrhythmias and Implantable Cardioverter–Defibrillator Therapies
Although ACEi/ARB was associated with no differences in overall recurrence of ventricular tachyarrhythmias, ACEi-ARB therapy was associatedWith improved freedom from appropriate ICD therapies within multivariable Cox regressions.
Hypertension Drug Therapy.
  • R. Hui
  • Medicine
    Advances in experimental medicine and biology
  • 2020
This reviewer studied comprehensively the literature, hopefully that the review will help improve antihypertensive drug selection and anti Hypertensive therapy.


Improving the efficacy of RAAS blockade in patients with chronic kidney disease
Current data support the implementation of lifestyle changes to reduce dietary sodium intake in combination with single-agent RAAS blockade, rather than dual- agent RAas blockade, as a potent and feasible strategy to mitigate the burden of renal and cardiovascular disease in patients with CKD.
Treatment of chronic kidney disease.
Treatment of chronic kidney disease can slow its progression to end-stage renal disease (ESRD), but the therapies remain limited and the incomplete application of existing treatments, the education of patients about their disease, and the transition to ESRD care remain major practical barriers to better outcomes.
Effects of NSAIDs on the Incidence of Hospitalisations for Renal Dysfunction in Users of ACE Inhibitors
This study strongly suggests an increased risk for hospitalisation for renal insufficiency in patients receiving ACE inhibitors who start using NSAIDs.
Angiotensin-converting enzyme inhibitor-associated elevations in serum creatinine: is this a cause for concern?
A strong association exists between acute increases in serum creatinine of up to 30% that stabilize within the first 2 months of ACEI therapy and long-term preservation of renal function and withdrawal of an ACEI in patients with preexisting renal insufficiency is recommended.
Concurrent use of diuretics, angiotensin converting enzyme inhibitors, and angiotensin receptor blockers with non-steroidal anti-inflammatory drugs and risk of acute kidney injury: nested case-control study
A triple therapy combination consisting of diuretics with angiotensin converting enzyme inhibitors or ang Elliotensin receptor blockers and NSAIDs was associated with an increased risk of acute kidney injury.
Effect of combining ACE inhibition with aldosterone blockade on proteinuria and renal damage in experimental nephrosis.
ACEi/aldoRB effectively reduced proteinuria and markers of tubular injury and prevented renal damage in this rat model of chronic proteinuria-induced renal damage.
Hyperkalemia associated with use of angiotensin-converting enzyme inhibitors and angiotensin receptor blockers.
  • M. Raebel
  • Medicine, Biology
    Cardiovascular therapeutics
  • 2012
The mechanism of action of ACEi and ARB coupled with judicious drug use and clinical vigilance can minimize the risk to the patient of developing hyperkalemia, and prompt recognition and management can optimize clinical outcome.
Nephrotoxicity in the Elderly Due to Co-Prescription of Angiotensin Converting Enzyme Inhibitors and Nonsteroidal Anti-Inflammatory Drugs
This drug combination is commonly nephrotoxic in the elderly and should be avoided, especially in those taking diuretics, and patients with deterioration in renal function were older and more likely to be on diuretic.
Angiotensin-converting enzyme inhibitors.
Ongoing studies will elucidate the effect of ACE inhibitor on cardiovascular mortality in essential hypertension, the role of ACE inhibitors in patients without ventricular dysfunction after myocardial infarction, and the roleof ACE inhibitors compared with newly available angiotensin AT1 receptor antagonists.