Which monitoring is recommended after starting ACE inhibitors or ARBs in CKD?

• A. Creatinine and potassium must be monitored due to possible changes
• B. No monitoring is needed
• C. Only monitor blood pressure
• D. Monitor calcium levels only

Answer: (A)

Starting ACE inhibitors or ARBs in CKD requires checking kidney function and potassium levels because these drugs can change how the kidneys work and how potassium is handled. By dilating the efferent arteriole, ACE inhibitors/ARBs can lower glomerular filtration pressure, which may cause creatinine to rise, especially in CKD where kidney reserve is limited. They also blunt aldosterone effects, reducing potassium excretion and raising the risk of hyperkalemia. Checking baseline creatinine and potassium before starting, then rechecking within about 1–2 weeks after initiation or dose increase, helps catch important changes early. If creatinine climbs significantly (often a rise ~30% or more) or potassium becomes elevated (above roughly 5.5–6 mEq/L), the therapy may need adjustment. Monitoring BP alone won’t detect these issues, and calcium levels aren’t the primary concern with initiating these medications in CKD.