ACE inhibitors, angiotensin receptor blockers and SGLT2 inhibitors reduce intraglomerular pressure, so eGFR commonly falls in the first weeks. Guidance generally accepts a rise in creatinine of up to about 30% without stopping treatment, provided the patient is well and potassium is acceptable.
A larger fall should prompt a search for volume depletion, interacting drugs such as NSAIDs or diuretics, or renal artery stenosis, rather than automatic discontinuation of a protective drug.
- Recheck creatinine and potassium one to two weeks after starting or up-titrating a RAS blocker.
- Continue treatment if creatinine rises by less than about 30% and the patient is well.
- Look for dehydration, NSAIDs or diuretic excess if the fall is larger.
- Do not stop SGLT2 inhibitors for the expected early eGFR dip.
Why it matters
Stopping kidney-protective drugs for an expected dip is a common and avoidable loss.
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