Serving To Educate Primary Care Clinicians On Metabolic Issues
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News: Prescriber's Letter June 2014
Questions often come up about how to safely use ACEIs or ARBs in patients with chronic kidney disease.
   We know these meds slow the progression of kidney disease.
   But blocking angiotensin can reduce kidney filtration...and sometimes lead to a bump in serum creatinine (SCr) and potassium.
   Think of ACEIs and ARBs as the "beta-blockers of the kidney." Expect increases in SCr just as you expect beta-blockers to decrease heart rate. Although the NUMBERS may look worse, the kidneys will be better off.
   Use these steps to help your patients benefit from an ACEI or ARB.
   Start with a moderate dose (lisinopril 10 to 20 mg/day, etc) for most patients with moderate renal impairment. Start with a lower dose in patients with severe renal impairment, heart failure, or over age 80.
   Titrate every 1 to 2 weeks to reach target doses and BP goals.

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