From the Guidelines
Diuretics should be held during Acute Kidney Injury (AKI) as they can reduce intravascular volume, renal blood flow, and/or glomerular filtration 1.
Antihypertensive Medications to be Held
- Diuretics: can exacerbate volume depletion and reduce renal blood flow 1
- Nonsteroidal anti-inflammatory drugs (NSAIDs): can cause kidney injury and alter renal blood flow 1
- Other medications that alter renal blood flow and intrarenal hemodynamics: such as certain antibiotics and chemotherapeutic agents 1
Antihypertensive Medications that Should Not be Held
- ACE inhibitors: should not be discontinued for minor increases in serum creatinine (<30%) in the absence of volume depletion 1
- Angiotensin receptor blockers (ARBs): should not be discontinued for minor increases in serum creatinine (<30%) in the absence of volume depletion 1 It is essential to note that the decision to hold or continue antihypertensive medications during AKI should be individualized and based on the patient's specific clinical circumstances, including the severity of AKI, volume status, and presence of hyperkalemia 1.
From the Research
Antihypertensive Medications to be Held During Acute Kidney Injury (AKI)
The following antihypertensive medications may need to be held or used with caution during AKI:
- ACE inhibitors and angiotensin receptor blockers (ARBs): Studies have shown that these medications may be associated with an increased risk of AKI, particularly in patients with pre-existing kidney disease 2, 3.
- Diuretics: Diuretics, especially loop diuretics, may worsen AKI by reducing renal perfusion and exacerbating volume depletion 3, 4.
- Diltiazem: The use of diltiazem has been associated with an increased risk of AKI in patients with acute intracerebral hemorrhage 5.
- Other medications: Other antihypertensive medications, such as beta-blockers and calcium channel blockers, may also need to be used with caution in patients with AKI, although the evidence is less clear.
Considerations for Medication Management in AKI
When managing antihypertensive medications in patients with AKI, the following considerations are important:
- Monitor renal function closely and adjust medications accordingly 2, 3.
- Avoid using medications that may worsen AKI, such as diuretics and certain antihypertensive agents 3, 4.
- Consider alternative medications or dose adjustments to minimize the risk of AKI 5, 2.
- Early recognition and treatment of AKI are crucial to preventing long-term kidney damage and improving patient outcomes 6, 4.