American Board of Internal Medicine (ABIM) Certification Practice Exam

What serum creatinine level is the cutoff for initiating ACE/ARB treatment?

1. 1

2. 2

3. 3

4. 4

The correct answer is: 3

The cutoff for initiating angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) treatment is typically a serum creatinine level of 3 mg/dL. This level indicates a significant renal function impairment that may benefit from these medications, particularly in patients with conditions such as hypertension, heart failure, or diabetic nephropathy. ACE inhibitors and ARBs are beneficial because they can help to lower blood pressure and provide renal protection by reducing intraglomerular pressure. For patients with chronic kidney disease (CKD), starting these medications at higher creatinine levels can help slow the progression of kidney injury and manage associated cardiovascular risks. In clinical practice, the initiation of these medications is generally avoided at substantial levels of kidney impairment (e.g., notably elevated creatinine levels above 3 mg/dL) without close monitoring, but evidence suggests that they remain beneficial even in patients with relatively higher creatinine levels, provided the risks are managed appropriately. This is why the specified level serves as an important indicator for treatment initiation.