Does an acute increase in serum creatinine of up to 30% after ACE inhibitor initiation predict long-term preservation of renal function?
An acute rise in serum creatinine of up to 30% after starting an ACE inhibitor is associated with long-term renal preservation and should not prompt drug withdrawal unless it exceeds 30% or hyperkalemia develops.
A strong association exists between acute increases in serum creatinine of up to 30% that stabilize within the first 2 months of ACEI therapy and long-term preservation of renal function. This relationship holds for persons with creatinine values of greater than 124 pmol/L (>1.4 mg/dL). Thus, withdrawal of an ACEI in such patients should occur only when the rise in creatinine exceeds 30% above baseline within the first 2 months of ACEI initiation, or hyperkalemia develops, ie, serum potassium level of 5.6 mmol/L or greater.
Bakris et al. (2000) studied this question.