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(Hypertension. 2001;38:639.)
© 2001 American Heart Association, Inc.

Renal Factors

Hyperkalemia, Renal Failure, and Converting-Enzyme Inhibition

An Overrated Connection

Néstor H. García; Sandra T. Baigorria; Luis I. Juncos

From IPEM-Gambro Healthcare and National University of Cordoba, Cordoba, Argentina.

Correspondence to Néstor H. García, MD, PhD, Instituto Privado de Especialidades Médicas S.A., Department of Renal Physiology, Pedro de Oñate 253, 5003 Córdoba, Argentina. E-mail ipem.sa{at}onenet.com.ar

Abstract

Abstract—— Hyperkalemia is widely viewed as a common complication of ACE inhibition in azotemic patients. These renal failure patients are the patients who benefit most from ACE inhibition. Because we could not confirm this notion after a retrospective evaluation of 236 azotemic patients, we studied 2 models of renal mass reduction. In the first, we did a 5/6 nephrectomy (Nx) on rats and studied them 2 weeks after surgery (before chronic renal changes had developed). A second group was studied 16 weeks after Nx, once chronic renal failure was established. Rats in both models were treated with quinapril in drinking water. After baseline evaluation, we challenged them either by a high-K⁺ diet or by blocking aldosterone receptors. We found that although quinapril blocked the K⁺-induced increase in aldosterone, serum K⁺ levels and K⁺ balance were maintained before and during high K⁺ intake or during simultaneous spironolactone administration. We conclude that in hemodynamically stable rats with reduced renal mass and renal dysfunction, the administration of an ACE inhibitor does not cause severe hyperkalemia.

Key Words: renin-angiotensin system • angiotensin converting-enzyme inhibitors • potassium • nephrectomy

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