Evaluation of renal function in elderly heart failure patients on ACE inhibitors
O M P Jolobe
Department of
Medicine for the Elderly, Tameside General Hospital, Fountain Street,
Ashton-under-Lyne OL6 9RW, Lancashire, UK
Accepted 30 November
1998
A total of 187 heart failure patients aged 65-92 years, with
pretreatment serum creatinine levels below 200 µmol/l, were monitored for more than 12 months on angiotensin-converting enzyme (ACE) inhibitor therapy. Optimal ACE inhibitor dosage was found in 27% of
patients, while a significant deterioration in renal function, characterised by >20% increase in serum creatinine to >200 µmol/l, occurred in 25 patients. This was most closely attributable to ACE
inhibitor treatment per se (implying
co-existence of bilateral renal artery stenosis) in only four cases,
including one in whom renal deterioration was reproducible on
inadvertent rechallenge. In the other 21, renal deterioration was
attributable to diuretic-related blood volume depletion (two cases),
nonsteroidal anti-inflammatory drugs (two cases), obstructive uropathy
(two cases), preterminal renal shutdown (two cases), and the
interaction between diuretic and ACE inhibitor dosage (including
long-acting vs short-acting drugs) (13 cases). This study could serve as the basis for future comparisons of
ACE-inhibitor-related renal deterioration when the entry requirement is
optimal ACE inhibitor dosage.
Keywords: heart failure; elderly patients; angiotensin-converting enzyme inhibitors; renal deterioration
© 1999 by The Fellowship of Postgraduate Medicine
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This article has been cited by other articles:
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Jolobe, O M P
(2001). Nephrotoxicity in the elderly due to co-prescription of ACE inhibitors and NSAIDs. JRSM
94: 657-658
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