What is a key consideration when starting ACE inhibitors or ARBs in CKD?

• A. Monitor for increases in creatinine and potassium; these drugs can reduce proteinuria and protect kidney function but require monitoring
• B. They cure CKD
• C. They always cause dangerous hyperkalemia
• D. They are contraindicated in CKD

Answer: (A)

Starting ACE inhibitors or ARBs in CKD hinges on balancing kidney protection with careful monitoring of electrolytes. These drugs reduce intraglomerular pressure, decrease proteinuria, and often slow CKD progression, which is why they’re beneficial in many patients with proteinuric kidney disease. But because they can impair the kidney’s ability to excrete potassium and can cause a small rise in creatinine after initiation or dose increases, you must check kidney function and potassium soon after starting and with any dose changes. If creatinine climbs significantly or potassium rises, you adjust the therapy accordingly. They are not cures for CKD, and they are not categorically contraindicated in CKD; rather, they’re used with vigilance to maximize benefit while minimizing risk.