Better guidelines are needed for monitoring of renal function during ACE inhibitor treatment

Despite widespread recognition that angiotensin converting enzyme inhibitors may cause renal failure in vulnerable patients, such cases still occur. Kalra et al (p 234) undertook three separate studies to investigate the adequacy of monitoring and the impact of admissions for uraemia related to use of these drugs in primary care. A postal questionnaire to general practitioners in North Wales showed 235/277 regularly checked renal function before, but only 93 after, the start of treatment; 42 never checked renal function. A similar pattern was seen in an audit of 162 patients treated with angiotensin converting enzyme inhibitors in one general practice. During a corresponding 12 month period these drugs were causally implicated in nine (7%) of 135 admissions for uraemia to one renal unit (only three had renovascular disease); though eight survived, the mean hospital stay was 21 days. The authors emphasise that many uraemic complications could be prevented by monitoring renal function in vulnerable patients.


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Relevant Article

Questionnaire study and audit of use of angiotensin converting enzyme inhibitor and monitoring in general practice: the need for guidelines to prevent renal failure

P A Kalra, M Kumwenda, P MacDowall, and M O Roland
BMJ 1999 318: 234-237. [Abstract] [Full Text] [PDF]