ACE Inhibitors in CKD Stage 3

Indications for ACE Inhibitors in CKD Stage 3

The Kidney International guideline recommends ACE inhibitors for patients with CKD stage 3 who have severely increased albuminuria without diabetes, with a strong recommendation 1
The Kidney International guideline suggests ACE inhibitors for patients with CKD stage 3 who have moderately increased albuminuria without diabetes 1
The Kidney International guideline recommends ACE inhibitors for patients with CKD stage 3 who have moderately-to-severely increased albuminuria with diabetes, with a strong recommendation 1
The American College of Cardiology recommends ACE inhibitors for patients with CKD stage 3 who have hypertension, to achieve target BP <130/80 mmHg 2, 3
The Kidney International guideline recommends ACE inhibitors for patients with CKD stage 3 who have heart failure with reduced ejection fraction 1

The Kidney International guideline recommends checking changes in blood pressure, serum creatinine, and potassium within 2-4 weeks of initiation or dose increase of ACE inhibitors in patients with CKD stage 3 1
The Kidney International guideline recommends continuing ACE inhibitor therapy unless serum creatinine rises by more than 30% within 4 weeks of starting treatment, or patient develops symptomatic hypotension, or uncontrolled hyperkalemia occurs despite medical treatment 1

The Kidney International guideline recommends starting with a low dose and titrating up, and aiming for the highest approved dose that is tolerated, as proven benefits were achieved in trials using these doses 1

The Kidney International guideline recommends continuing ACE inhibitor even when eGFR falls below 30 ml/min per 1.73 m² 1
The Kidney International guideline strongly recommends avoiding any combination of ACE inhibitor, ARB, and direct renin inhibitor in people with CKD 1