HelixTalk Episode #117 - The Yin and Yang of ACEi/ARBs:How Do They Help and Harm Kidneys?

Date posted: August 11, 2020, 6:00 am

In this episode, we dive into the pharmacology of ACE inhibitors and ARBs, particularly understanding how they assist in preserving renal function in CKD and yet at the same time can harm the kidneys (e.g. cause AKI).

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Key Concepts

1. ACE inhibitors and ARBs work in the RAAS system to inhibit angiotensin II and subsequently decrease proteinuria and progression of CKD.
2. ACEi/ARBs result in vasodilation of both efferent and afferent arteriole which decreases glomerular pressure and decreased proteinuria.
3. Patients with CKD are at an increased risk of ACEi/ARB-induced acute kidney injury and hyperkalemia and thus monitoring for these adverse effects upon initiation as well as routinely is very important.
4. Combining ACEi and ARB may produce greater reduction in proteinuria, but there is no translation to decreased progression to CKD. In some cases, harm such as increased rates of ESRD and doubling of Scr are noted with combined use. 

References

1. National Kidney Foundation. K/DOQI clinical practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Am J Kidney Dis. 2002;39(2 Suppl 1):S1-S266.
2. American Diabetes Association. 11. Microvascular Complications and Foot Care: Standards of Medical Care in Diabetes-2020. Diabetes Care. 2020;43(Suppl 1):S135-S151. doi:10.2337/dc20-S011