Would you stop an ACE inhibitor/ARB or instead initiate a potassium binder to manage hyperkalemia in a patient with proteinuric CKD stage 5 who is on an ACEi/ARB?
Answer from: at Community Practice
This depends on where in CKD 5 the patient is, to some extent. Would also make sure to modify diet if possible and make sure on an appropriate dose of a loop diuretic. If very close to starting dialysis or getting a txp, I might reduce dose or stop, especially if a K-binder is expensive for the pati...
Comments
at Yonkers Nephrology Pc Totally agree!
at Davita Ocoee Home Training Agree
at Markims Nephrology Network Inc. If the patient's compliance with the K binder is p...
at University of Wisconsin System Agree. When bringing that up I always like to tell...
This is a situation where 'one size does not fit all "and has to be approached per individual patient risk of progression of renal failure and life-threatening hyperkalemia with limited reward of halting /slowing progression.
ACE-I’s and ARB’s have been shown to slow the progression of CKD, especially in patients with proteinuria. If potassium elevation is considered to be a problem, potassium binders are an excellent treatment to prevent high potassium levels and continue patients on drugs that act on the RA...
I would always keep the inhibition of the RAAS to continue in a patient with CKD and proteinuria. Lowering K with a K binder is a safe and effective way to maintain the renal protection offered by either an ACE-I or an ARB without causing hyperkalemia complicating the continuing inhibition of the RA...
Totally agree!
Agree
If the patient's compliance with the K binder is p...
Agree. When bringing that up I always like to tell...