Continuation of Telmisartan During Acute Kidney Injury
Telmisartan should be temporarily withheld during the acute AKI phase when clinical circumstances include sepsis, hypovolaemia, or hypotension. [1] Telmisartan should be restarted after recovery and clinical stabilisation following the episode of AKI, using reassessment for contraindications and close monitoring of kidney function and potassium. [2]
Acute Phase Medication Management
Temporarily stopping ACE inhibitors and ARBs during acute diarrhoea, vomiting, or sepsis is recommended until clinical condition improves and stabilises. [1]
Post-AKI Reinitiation Criteria
Reinitiation should be guided by the original indication for RAAS inhibition. [2]
Contraindications should be assessed before restarting, including severe bilateral renal artery stenosis. [2]
For patients previously stabilised on RAAS inhibitors for chronic kidney disease with albuminuria, re-starting is recommended unless a new contraindication exists, including pre-treatment serum potassium greater than 5.0 mmol/L. [2]
For patients previously stabilised on RAAS inhibitors for essential hypertension, the AKI episode should prompt antihypertensive strategy review, with follow-up within 6 weeks after discharge. [2]
Practical Restart Approach After Clinical Stabilisation
Restarting should occur after the acute trigger resolves and renal perfusion stabilises. [1] Restarting should use low-dose titration when required based on stability and risk of recurrent AKI or hyperkalaemia. [2]
Monitoring After Restart
Renal function and serum potassium should be re-checked after AKI recovery to support safe re-initiation and titration. [2]
Common Reasons to Avoid Restart
Restart should not occur when a specific contraindication to ARB/ACE inhibitor therapy has been identified (example given: severe bilateral renal artery stenosis). [2] Restart should not occur when pre-treatment serum potassium exceeds 5.0 mmol/L. [2]
Key Decision Point for Telmisartan
Telmisartan should be held during the acute AKI phase with sepsis, hypovolaemia, or hypotension. [1] Telmisartan should be restarted after clinical improvement and stabilisation, after review of indication and contraindications, with assessment for hyperkalaemia and follow-up planning after discharge. [1,2]