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Angiotensin converting enzyme inhibitor-induced renal dysfunction: recommendations for prevention
1Massachusetts College of Pharmacy and Allied Health Sciences, Beth Israel Hospital, Boston, MA 02115.
Insights
Angiotensin converting enzyme inhibitors (ACE inhibitors) benefit cardiovascular health and can improve kidney function. However, clinicians must recognize risk factors to prevent potential ACE inhibitor-induced renal dysfunction.
Area of Science:
- Cardiology
- Nephrology
- Pharmacology
Background:
- Angiotensin converting enzyme inhibitors (ACE inhibitors) are primary treatments for cardiovascular diseases like heart failure and hypertension.
- These drugs offer hemodynamic benefits and minimal adverse effects on cardiovascular risk factors.
- Judicious use of ACE inhibitors may enhance renal function.
Purpose of the Study:
- To review factors increasing the risk of ACE inhibitor-induced renal dysfunction.
- To provide recommendations for preventing ACE inhibitor-induced renal dysfunction.
Main Methods:
- Literature review of factors contributing to ACE inhibitor-induced renal dysfunction.
- Analysis of clinical conditions where ACE inhibitors impact renal function.
- Identification of risk factors and preventive strategies.
Main Results:
- ACE inhibitors can improve renal function by causing vasodilation, beneficial in hyperadrenergic states, diabetic nephropathy, and proteinuric renal disease.
- Certain circumstances and patient factors can lead to ACE inhibitor-induced renal dysfunction.
- Recognizing predisposing factors is crucial for preventing adverse renal effects.
Conclusions:
- While ACE inhibitors offer renal protection, potential for renal dysfunction exists.
- Clinicians must identify and manage risk factors to prevent ACE inhibitor-induced renal dysfunction.
- Preventive strategies are essential for safe ACE inhibitor use in susceptible patients.
Abstract:
The angiotensin converting enzyme inhibitors constitute a major treatment modality for cardiovascular diseases, including congestive heart failure and hypertension. In addition to their beneficial hemodynamic effects, they offer other advantages, such as a relative lack of adverse effects on other cardiovascular risk factors. When used judiciously, the angiotensin converting enzyme inhibitors may also contribute to improved renal function. These agents induce vasodilation of both efferent and afferent renal vessels, which may facilitate improved renal blood flow and glomerular filtration rate in individuals whose renal insufficiency results from hyperadrenergic activity. Improvements in renal function may also be observed when angiotensin converting enzyme inhibitors are employed in other clinical conditions, such as diabetic nephropathy or proteinuric renal disease. Although the renal protective effects of the angiotensin converting enzyme inhibitors are well recognized, their use in certain circumstances may actually contribute to renal dysfunction. The factors which may predispose an individual to angiotensin converting enzyme inhibitor-induced renal dysfunction must be recognized by the clinician and appropriate interventions taken to prevent this potentially deleterious effect. This article reviews those factors which increase risk for angiotensin converting enzyme inhibitor-induced renal dysfunction and provides recommendations for prevention.