Related Experiment Video

Updated: Mar 22, 2026

A Large Animal Model for Acute Kidney Injury by Temporary Bilateral Renal Artery Occlusion
09:02

A Large Animal Model for Acute Kidney Injury by Temporary Bilateral Renal Artery Occlusion

Published on: February 2, 2021

5.0K

Acute Kidney Injury in Elderly Patients With Chronic Kidney Disease: Do Angiotensin-Converting Enzyme Inhibitors

Martin Chaumont1, Aline Pourcelet1, Marc van Nuffelen2

  • 1Department of Nephrology, Dialysis and Renal Transplantation, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium.

Journal of Clinical Hypertension (Greenwich, Conn.)
|April 16, 2016
PubMed

Insights

Patients with chronic kidney disease (CKD) using angiotensin-converting enzyme (ACE) inhibitors face increased risk of acute kidney injury (AKI), especially with dehydration. Adjusting ACE inhibitor dosage or switching to ARBs can reduce AKI incidence.

Area of Science:

  • Nephrology
  • Pharmacology
  • Internal Medicine

Background:

  • Angiotensin-converting enzyme (ACE) inhibitors are renally cleared, necessitating dosage adjustments in chronic kidney disease (CKD) patients to prevent acute kidney injury (AKI).
  • Angiotensin receptor blockers (ARBs) are hepatically cleared, posing different risks in CKD.
  • Community-acquired AKI is a significant concern in CKD patients, particularly those using renin-angiotensin system inhibitors.

Purpose of the Study:

  • To assess the association between ACE inhibitor or ARB use and community-acquired AKI in patients with advanced CKD.
  • To identify risk factors for AKI in this patient population.
  • To inform clinical practice regarding ACE inhibitor and ARB management in CKD.

Main Methods:

  • Retrospective assessment of 324 patients with baseline stage 3 or higher CKD.
  • Analysis of community-acquired AKI incidence and medication use (ACE inhibitors, ARBs).
  • Stepwise regression analysis to identify independent predictors of AKI.

Main Results:

  • ACE inhibitor use was significantly associated with AKI (OR, 1.9; P=.02).
  • Dehydration was a strong predictor of AKI (OR, 30.8).
  • Overdosing of ACE inhibitors occurred in 45% of users, contributing to excess AKI risk.

Conclusions:

  • Dosage adjustment of ACE inhibitors based on renal function or switching to ARBs may decrease AKI incidence in CKD patients.
  • ACE inhibitors and ARBs should be discontinued in cases of dehydration to mitigate AKI risk.
  • This study highlights the importance of medication management in CKD patients to prevent AKI.

More Related Videos

Improved Renal Denervation Mitigated Hypertension Induced by Angiotensin II Infusion08:35

Improved Renal Denervation Mitigated Hypertension Induced by Angiotensin II Infusion

Published on: May 26, 2022

4.4K
Nephrotoxin Microinjection in Zebrafish to Model Acute Kidney Injury07:58

Nephrotoxin Microinjection in Zebrafish to Model Acute Kidney Injury

Published on: July 17, 2016

9.3K

Related Concept Videos

Acute Kidney Injury IV: Diagnostic Studies and Prevention01:30

Acute Kidney Injury IV: Diagnostic Studies and Prevention

Accurate diagnosis and effective prevention are critical in managing Acute Kidney Injury (AKI), which is linked to high mortality rates ranging from 10% to 80%. Timely recognition of at-risk patients and careful monitoring can significantly reduce the likelihood of kidney damage.Diagnostic Assessments:The diagnostic process starts with a comprehensive medical history to identify prerenal, intrarenal, and postrenal causes.Prerenal causes, such as dehydration, hypotension, or blood loss, should...
459
Acute Kidney Injury I: Introduction01:22

Acute Kidney Injury I: Introduction

Introduction:Acute Kidney Injury (AKI) describes a swift decrease in kidney function occurring over hours to days, characterized by the kidneys' failure to remove waste products from the bloodstream. This leads to dangerous complications like metabolic acidosis, fluid overload, and electrolyte imbalances, such as hyperkalemia, which can cause life-threatening arrhythmias. AKI is common in both hospital and outpatient settings, often triggered by dehydration, sepsis, or exposure to nephrotoxic...
1.1K
Acute Kidney Injury V: Interprofessional Care01:20

Acute Kidney Injury V: Interprofessional Care

Acute Kidney Injury (AKI) requires a collaborative healthcare approach to restore renal function and prevent complications. Essential management strategies involve monitoring fluid and electrolyte balance, adjusting medications, initiating dialysis when necessary, and providing nutritional support.Fluid and Electrolyte ManagementFluid Monitoring: Regularly monitoring body weight, central venous pressure, and urine output helps detect fluid imbalances early. Patient intake and output are...
453
Acute Kidney Injury III: Clinical Manifestations01:29

Acute Kidney Injury III: Clinical Manifestations

Acute Kidney Injury (AKI) progresses through distinct clinical phases: the oliguric, diuretic, and recovery phases, each marked by unique manifestations and challenges.Oliguric Phase:The oliguric phase is the initial stage of AKI, typically lasting 10 to 14 days. This phase is marked by a significant reduction in urine output, usually less than 400 mL per day, indicating decreased kidney function. Fluid retention is a prominent feature, leading to symptoms such as edema, hypertension, and...
1.3K
Acute Kidney Injury II: Pathophysiology01:29

Acute Kidney Injury II: Pathophysiology

Acute kidney injury (AKI) causes are categorized into three primary categories based on the location of the injury: prerenal, intrarenal (or intrinsic), and postrenal causes. This classification guides clinical management and illustrates how different pathways can impair kidney function.Etiology and Pathophysiology of Acute Kidney Injury1. Prerenal causesEtiology: Prerenal Acute Kidney Injury, the most common type, occurs when reduced blood flow to the kidneys decreases filtration capacity...
1.7K
Pharmacokinetics in Geriatric Patients: Effect of Age on Drug Excretion01:18

Pharmacokinetics in Geriatric Patients: Effect of Age on Drug Excretion

In geriatric patients, renal physiology undergoes significant changes, including diminished renal blood flow and a lower glomerular filtration rate (GFR), leading to alterations in medication clearance. Drugs such as aminoglycoside antibiotics, lithium, and digoxin, which rely on glomerular filtration for removal from the body, particularly impact pharmacokinetics. These drugs tend to have slower clearance rates in older adults, necessitating careful dosage considerations.Evaluation of renal...
310