Benazepril in dogs with kidney disease: hyperkalaemia and creatinine
9-year-old Labrador with proteinuric IRIS stage 2 CKD (UPC 2.4) that started benazepril 2 weeks ago. He is well, eating and drinking normally. His diet is home-made, based on meat and vegetables, with a multivitamin supplement.
| Parameter | Result | Reference |
|---|---|---|
| Creatinine | 1.9 mg/dL (previously 1.7) | 0.5–1.5 |
| Potassium | 6.1 mmol/L (previously 5.2) | 3.5–5.5 |
What is the most appropriate course of action?
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A. Continue benazepril, review the diet and supplements (potassium sources) and recheck; reduce the dose if hyperkalaemia persists or worsens
Correct. A mild rise in creatinine is expected from the drug's haemodynamic effect. Moderate hyperkalaemia without signs is managed first by switching to a lower-potassium diet (for example, a commercial renal diet) before abandoning antiproteinuric treatment.
B. Permanently stop any ACE inhibitor or ARB, because the creatinine rise indicates nephrotoxicity
A small creatinine rise is not nephrotoxicity, and stopping completely leaves significant proteinuria, a progression factor, untreated.
C. Add spironolactone to enhance the antiproteinuric effect
Spironolactone is a potassium-sparing diuretic: added to the ACE inhibitor it would worsen hyperkalaemia.
D. Double the benazepril dose, because the UPC has not yet been reassessed
Increasing the dose with hyperkalaemia would worsen it. The dose is adjusted according to UPC only when creatinine and potassium are stable.
lightbulb Key takeaway
After starting or adjusting an ACE inhibitor or ARB, measure creatinine, potassium and blood pressure at 1–2 weeks. With moderate hyperkalaemia, review the diet first (home-made diets are often high in potassium); severe hyperkalaemia (above 6.5–7 mmol/L) requires dose reduction or withdrawal.
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Updated: October 31, 2026 · Educational content for veterinary professionals. It does not replace current clinical guidelines or the judgement of the attending veterinarian.