- Monitor for changes in BP, serum creatinine, & serum K+ within 2–4 weeks of initiation or increase in the dose of an ACEi or ARB.
- Continue ACEi or ARB therapy unless serum creatinine rises by > 30% within 4 weeks following initiation of treatment or an increase in dose.
- FDA recommends, metformin should NOT be used with serum creatinine ≥ 1.5 mg/dl in men & ≥ 1.4 mg/dl in women or with decreased creatinine clearance in people > 80.
- Recommended is treating patients with T2D, CKD, & an eGFR ≥ 30 ml/min per 1.73 m2 with metformin.
ADA/KDIGO Consensus Statements:
All patients with Type 1 diabetes or Type 2 diabetes and CKD should be treated with a
comprehensive plan, outlined and agreed by health care professionals and the patient
together, to optimize nutrition, exercise, smoking cessation, and weight, upon which are
layered evidence-based pharmacologic therapies aimed at preserving organ function and
other therapies selected to attain intermediate targets for glycemia, blood pressure, and lipids.
