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Chapter 35. Chronic Kidney Disease/End Stage Renal Disease

In a patient with underlying chronic kidney disease and proteinuria, which of the following medications have the indication for hypertension (HTN) and work by inhibiting the renin angiotensin aldosterone system (RAAS)? Select all that apply.

a. benazepril

b. Mavik

c. losartan

d. amlodipine

e. Toprol XL

Answer a is correct. HTN is a risk factor for progression of kidney disease by accelerating proteinuria and activation of the RAAS. When tolerated, angiotensin converting enzyme (ACE) inhibitors or angiotensin II receptor blockers (ARBs) are considered first-line therapy for blood pressure control and to reduce albuminuria. Benazepril (Lotensin) is an ACE inhibitor.

Answer b is correct. Trandolapril (Mavik) is an ACE inhibitor.

Answer c is correct. Losartan (Cozaar) is an ARB.

Answer d is incorrect. Amlodipine (Norvasc) is a dihydropyridine calcium channel blocker and may cause peripheral edema (fluid retention may be a manifestation of kidney disease).

Answer e is incorrect. Metoprolol (Toprol XL) is a β-blocker.

For the primary prevention of cardiovascular disease in a patient with chronic kidney disease (CKD), which medication inhibits platelet aggregation?

a. Lisinopril

b. Metformin

c. Aspirin

d. Amlodipine

Answer c is correct. Patients with CKD are at increased risk of CV mortality. Consideration for low-dose aspirin 81 mg by mouth daily may minimize bleeding risk while providing heart protection through inhibition of platelet aggregation.

Answer a is incorrect. While lisinopril may assist with blood pressure control which may decrease CV mortality, it works through the renin angiotensin aldosterone system.

Answer b is incorrect. Metformin, an antidiabetic agent, is a medication of concern in patients with CKD as it may increase likelihood of lactic acidosis and is best avoided.

Answer d is incorrect. Amlodipine (Norvasc) is a dihydropyridine calcium channel blocker and may cause peripheral edema (fluid retention may be a manifestation of kidney disease).

A 44-year-old man with end-stage renal disease (receives hemodialysis on Monday-Wednesday-Friday), diabetes, hypertension, and peripheral neuropathy presents to the pharmacist for optimization of medication therapy. Since the start of hemodialysis a month prior, the patient states that he has difficulty remembering to take his medications with meals and he has experienced two episodes of hypoglycemia. He denies medication or food allergies and does not recall his recent immunizations.

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