ACE Inhibitors: Still a role for 40 year old drugs?

The Rest is Kidneys podcast series is brought to you by Imperial College Healthcare NHS Trust and North West London Integrated Care Board (NWL NHS)

In this episode, Jeremy Levy and Andrew Frankel discuss the role of renin-angiotensin-aldosterone system inhibitors (RAASi) in the management of chronic kidney disease (CKD), looking deeper into the mechanisms, benefits and practical considerations of using RAASi. 

They cover when to initiate these medications, the importance of maximum dosing, monitoring kidney function, and managing side effects like changes in GFR and potassium levels.

Key Takeaways:

1. RAASi Benefits Beyond Blood Pressure:
   • These drugs lower blood pressure, slow CKD progression, and provide cardiovascular protection through mechanisms independent of blood pressure control.
   • Maximum dosing is essential for optimal kidney and heart protection.
2. Monitoring and Managing GFR Changes:
   • A GFR drop of up to 25% after starting RAASi is not a cause for concern.
   • Clinicians should reassure patients and recheck levels to ensure stability.
3. Potassium Management:
   • Mild to moderate increases in potassium (up to 6 mmol/L) are common and generally not an emergency.
   • Careful monitoring, addressing potential contributing factors, and avoiding unnecessary panic are key.

This episode provides practical insights and actionable advice for clinicians managing CKD patients.

Resource Links:
NICE GUIDELINES [NG203] chronic kidney disease: assessment and management Overview | Chronic kidney disease: assessment and management | Guidance | NICE

Northwest London CKD guidelines for primary care Chronic kidney disease (nwlondonicb.nhs.uk)

The purpose of this podcast is to inform and educate health care professionals working in the primary care and community setting. The content is evidence based and consistent with NICE guidelines and North West Guidelines available at the time of publication.

The content of this podcast does not constitute medical advice and it is not intended to function as a substitute for a healthcare practitioner’s judgement.

Produced by award-winning media and marketing specialist Heather Pownall of Heather's Media Hub

Chapters

• 1:44 Why talk about RAASi's and why do we recommend them as the first line treatments in people with chronic kidney disease?
• 4:28 These drugs have effects that are beneficial for the kidneys separate from the blood pressure lowering
• 5:29 Who are the groups to use these drugs?
• 7:07 Practically what are the considerations to think about?
• 10:52 GRF fall when to worry and when not to worry
• 16:56 Episode summary