ACE inhibitors: Safe for people with kidney disease?

Angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs) are often the first medications used to treat high blood pressure in people with kidney disease. ACE inhibitors and ARBs are a good choice because they lower blood pressure and help protect the kidneys from further damage. However, these medications must be used with appropriate caution.

All ACE inhibitors and ARBs initially increase serum creatinine and potassium levels. But this increase may be only temporary. Sometimes ACE inhibitors and ARBs cause a persistent decline in kidney function marked by an increase in both serum creatinine and potassium levels. For this reason, your doctor may want to recheck these levels within three to five days after you start the medication.

If your serum creatinine and potassium levels are high, your doctor will likely adjust your dosage and then recheck your levels again in three to five days. Typically, a dose can be identified that will lower blood pressure while maintaining acceptable kidney function and serum potassium levels.

It is important to note that the blood pressure goal in people with kidney disease is 125/75 millimeters of mercury (mm Hg) or lower.