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2012/06/25

Use of ACEI and ARB in Serious Chronic Kidney Disease

Current there has been much debate regarding the use of inhibitors of the renin-angiotensin-aldosterone system (RAAS), namely angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs) in the severe chronic kidney disease (CKD) patient.

ACE inhibitors act within the RAAS by inhibiting the conversion of angiotensin I to angiotensin II and, thereby, opposing its physiologic effects on aldosterone secretion, arteriolar vasoconstriction, and water and salt retention. ARBs act at the receptor level to produce a similar effect (Saseen & Carter, 2005).You may like to read this article:Application of ACEI and ARB in Treatment for Kidney Disease

For a number of years, caution has been used when prescribing inhibitors of the RAAS in patients with CKD due to their cited potential to decrease glomerular filtration rate (GFR), increase serum creatinine levels and result in hyperkalemia (Morimoto, et al., 2004). Ironically, patients with CKD were initially excluded from many of the clinical trials that led to the discovery of ACE inhibitors' renoprotective effects (Maschio, et al., 1996). Some literature now suggests that these agents remain renoprotective regardless of the patient's stage of kidney disease (Hou, Zhang, & Zhang, 2006; Ruggenenti, Perna, Remuzzi & Gruppo Italiano di Studi Epidemiologici in Nefrologia, 2001). This controversy may result in these medications being withheld from patients who may benefit from their use or cause them to be used when they may not be appropriate.

Now you must have a clear understanding about the use of ACEI and ARB in the treatment for chronic kidney failure. Proper use of these two kinds of blood pressure reducing drugs can help you better treat your kidney disease.
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