Lisinopril Dosing and Monitoring in Renal Impairment

Introduction to Lisinopril Use in Renal Impairment

• The American Journal of Kidney Diseases recommends assessing GFR and serum potassium within 1 week of starting lisinopril therapy or any dose escalation in patients with GFR <60 mL/min/1.73 m² 1
• The American Journal of Kidney Diseases suggests that ACE inhibitors, such as lisinopril, remain nephroprotective in patients with GFR <30 mL/min/1.73 m² and should not be routinely discontinued 1

Temporary Discontinuation and Monitoring

• The American Journal of Kidney Diseases recommends temporarily suspending lisinopril during serious intercurrent illness that increases AKI risk, planned IV radiocontrast administration, bowel preparation prior to colonoscopy, prior to major surgery, and volume depletion states 1, 3, 4
• The Diabetes Care journal advises against discontinuing ACE inhibitors for creatinine increases ≤30% in the absence of volume depletion 4

Special Considerations

• The American Journal of Kidney Diseases advises against starting lisinopril in suspected bilateral renal artery stenosis or functional renal artery stenosis 1
• The Kidney International journal suggests that significant drug accumulation is expected in patients with GFR <10 mL/min/1.73 m² or those undergoing hemodialysis 3
• The Diabetes Care journal recommends monitoring for hyperkalemia development in patients with renal impairment 4