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Renal function after new treatment with renin-angiotensin system blockers

BMJ 2017; 356 doi: (Published 09 March 2017) Cite this as: BMJ 2017;356:j1122
  1. Marie Valente, senior clinical trial coordinator1,
  2. Sunil Bhandari, consultant nephrologist/honorary clinical professor2
  1. 1Birmingham Clinical Trials Unit, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
  2. 2Department of Renal Medicine, Hull and East Yorkshire Hospital NHS Trust and Hull York Medical School, Kingston upon Hull HU32JZ, UK
  1. Correspondence to: S Bhandari Sunil.bhandari{at}

Even small increases in creatinine concentration could signal a higher risk of poor outcomes

Use of angiotensin converting enzyme inhibitors (ACEI) and angiotensin II receptor blockers (ARB) to block action of the renin-angiotensin-aldosterone system is a mainstay of treatment for hypertension, heart failure, and diabetic and proteinuric nephropathy, as well as post-myocardial infarction therapy.123 However, in some patients, renal function declines sharply when they start treatment with these agents. Current guidelines recommend monitoring renal function before and after starting ACEI or ARB and suspending treatment if creatinine concentration increases by more than 30%.

Schmidt and colleagues (doi:10.1136/bmj.j791) used two powerful UK databases—the Clinical Practice Research Datalink and Hospital Episode Statistics—to carry out a population based cohort study.4 They suggest that a 10-30% rise in serum creatinine after the start of treatment can predict increased risk of adverse renal and cardiac outcomes or death, even after correction for baseline renal function. As renin-angiotensin system blockers are among the most prescribed drugs in the UK, balancing the …

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