The Effect of Withdrawal of Angiotensin II Blockers on Serum Creatinine and Potassium in Patients with Chronic Kidney Disease

BACKGROUND: Renin-angiotensin system (RAS) blockers have been used to delay the progression of various renal diseases, but these medications cause hyperkalemia and the elevation of serum creatinine which impede the continuation of the medications. So far, there have been no data which observe the changes of serum creatinine or serum potassium after withdrawal of the RAS blockers. In addition, no guidelines have been established regarding the continuation of the RAS blockers in case of rapidly rising serum creatinine in patients who have been on these medications more than 2 months. Hence, we sought to determine the changes of serum creatinine, glomerular filtration rate (GFR) and serum potassium after withdrawal of RAS blockers in the current study. METHOD: We retrieved medical records of 1,154 outpatients with chronic kidney diseases (diadetic nephropathy n=574, chronic glomerulonephritis n=580) who received angiotensin-converting-enzyme inhibitors (ACEI) or angiotensin II receptor blockers (ARB) between March 1995 and May 2005. Of these 1,154 patients, 60 patients were found to stop the RAS blocker treatment due to the elevation of serum creatinine (elevated creatinine group, n=37) or hyperkalema (hyperkalemia group, n=23). The end points of the study were the initiation of renal replacement therapy, restart of ACEI / ARB therapy or 6 months after withdrawal of ACEI / ARB, whichever comes first. RESULTS: Sixty patients were enrolled for the study (elevated serum creatinine n=37, hyperkalemia n=23). In the elevated serum creatinine group, the duration of therapy before the withdrawal was 24.9 ± 27.3 months. The serum creatinine and serum potassium values at the point of withdrawal were 4.0 ± 1.8 mg/dL and 5.1 ± 0.9 mEq/L, respectively. After discontinuation of the medications, a decrease in serum creatinine and an increase in GFR were noted at one month. After one month, however, serum creatinine was continuously increased up to 6 months. The mean slope of GFR indicates that the rate of the decline of GFR was lower after the withdrawal of the medications compared to the period before the withdrawal (-0.722 / -1.132 versus -2.108 mL/min/1.73m2/month). In the hyperkalemia group, the duration of therapy before the withdrawal was 23.5 ± 24.0 months. The serum creatinine and serum potassium values at the point of withdrawal were 3.0 ± 1.0 mg/dL and 6.4 ± 0.4 mEq/L, respectively. Significant decrease in serum potassium was noted after withdrawal which was persistent up to 6 months. The transient decrease of serum creatinine, observed in the creatinine group, was not seen in this group. CONCLUSION: It was found that there is a beneficial effect on serum creatinine and GFR in the immediate period after the withdrawal of RAS blockers when such agents were stopped due to a relatively rapid rise in the serum creatinine concentration. The serum potassium levels were consistently decreased after the withdrawal of RAS blockade in both elevated creatinine and hyperkalemia groups. Further studies are required to establish the guideline on the continuation of RAS blockade in patients with rapidly rising serum creatinine levels.

Author dc:creator

• 정, 혁준

Contributors dc:contributor

• 김, 흥수
• 대학원 의학과
• 101683

• 레닌 안지오텐신계 억제제
• 안지오텐신 II 수용체 차단제
• 만성 신부전
• 고칼륨혈증

Language dc:language

ko

Identifier

http://dcoll.ajou.ac.kr:9080/dcollection/jsp/common/DcLoOrgPer.jsp?sItemId=000000001190
000000001190

OAI identifier oai:identifier

oai:repository.ajou.ac.kr:201003/1567