Do you recommend initiating an ACE inhibitor or ARB in a patient with proteinuric CKD Stage 5?

ACE-I’s and ARB’s have been shown to be renal protective, and patients who have stopped these agents do worse than those who continue them.

Potassium binders are an excellent option to lower K levels and enable patients to stay on these RAAS inhibitors.

I would not take CKD patients off RAAS inhibit...

I would if the potassium is less than 4.8. I would repeat potassium in 2 weeks after starting to make sure it has not gone up. If it is more than 5 after starting then would stop. Of course, if the eGFR is really low or the patient is symptomatic will start dialysis and then consider starting ACE/AR...

Patients with advanced CKD and diabetic nephropathy get the same benefits from RAAS blockade, but I use a GFR cutoff of 19 (as per data from RENAAL trial, where the tertile of 19-34 had 10% less ESRD risk with losartan vs placebo). Stopping RAAS blockade is associated with worse survival but the sam...