What is the evidence regarding the use of ACE-I in those with CKD and HFREF?
The evidence suggested that ACE-I are efficacious and do not result in excess renal complications (such as hyperkalaemia). The committee agreed that ACE-I should be used as part of first-line treatment, as in the general HFREF population. However, people with both CKD and HFREF appear not to get the same increased benefit of a high dose ACEI-I seen in the general HFREF population, perhaps because of additional renal adverse effects related to the drug. The committee agreed that prescribers may wish to carefully consider the utility of titrating to the highest doses in this population, as a lower dose may be just as effective overall, when the potential harms are weighed against the benefits. The high absolute risk of hyperkalaemia was not felt to be a reason to withhold these effective drugs, but should lead to increased attention in monitoring.