Starting an ACE inhibitor, angiotensin receptor blocker or SGLT2 inhibitor usually causes a modest fall in eGFR within the first weeks, reflecting reduced glomerular pressure rather than kidney injury. A fall of up to about 30% is commonly accepted, and the drug should usually be continued. Recheck creatinine and potassium within two to four weeks. A larger fall should prompt a search for volume depletion, interacting drugs such as NSAIDs, or renal artery stenosis, rather than automatic withdrawal.
- Check creatinine and potassium two to four weeks after starting or increasing these drugs.
- Accept a modest eGFR dip and continue treatment.
- Investigate a fall of more than about 30% for dehydration, NSAIDs or renovascular disease.
- Avoid stopping kidney-protective drugs on a single creatinine reading.
Why it matters
Stopping these drugs for an expected dip removes their long-term kidney and heart protection.
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