Renal handling of angiotensin receptor blockers: clinical relevance

Angiotensin receptor blockers (ARBs), like angiotensin-converting enzyme (ACE) inhibitors, are commonly used in the setting of chronic kidney disease. The use of drugs in this class, or for that matter any drug in the renally compromised patient, should raise consideration of the impact of renal disease on the systemic elimination of the compound. Unlike most of the drugs in the ACE inhibitor class, the compounds making up the ARB class undergo significant hepatic elimination; thus, in the renal failure patient, they are not prone to relevant degrees of systemic accumulation with repetitive dosing. ARBs do not require dose adjustment in renal failure on the basis of their pharmacokinetic pattern; rather, dose reduction should be an empiric process dictated by having reached or exceeded the goal established for blood pressure reduction.