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Short-term effects of calcium antagonists on renal haemodynamics in patients with chronic renal failure
J P Wight1, C B Brown, A M el Nahas
1Sheffield Kidney Institute, Northern General Hospital, UK.
Abstract:
Experimental evidence suggests that pharmacological manipulations of glomerular haemodynamics may affect the progression of chronic renal insufficiency and scarring. In this study, we have investigated the short-term (4 weeks) renal haemodynamic effects of nifedipine and nitrendipine (10 mg/thrice daily) in two separate groups of 6 patients with stable chronic renal failure (CRF) (glomerular filtration rate, GFR: 9.7-47.8 ml/min/1.73 m2). Patients were studied on three occasions: (1) before the administration of the calcium antagonist, (2) after 4 weeks of treatment and (3) 4 weeks after the discontinuation of the drug. Mean arterial pressure fell significantly on nifedipine: from 116.33 +/- 12.25 to 107.22 +/- 18.67 mm Hg, p less than 0.05, and on nitrendipine: from 112.22 +/- 10.04 to 102.22 +/- 13.77 mm Hg, p less than 0.05. There was no significant effect of either calcium antagonist on GFR, effective renal plasma flow (ERPF), proteinuria or natriuresis. Consequently, renal vascular resistance (RVR) fell in both experimental groups, nifedipine: from 51.40 +/- 28.77 to 44.97 +/- 30 dyn s cm-5 x 10(3) (mean +/- SD), and nitrendipine: from 37.04 +/- 18.46 to 30.47 +/- 15.56 dyns s cm-5 x 10(3), p less than 0.05. These results show that calcium antagonists reduce systemic blood pressure whilst GFR and ERPF are maintained. The fall in the RVR of patients with CRF treated with calcium antagonists may confer on these agents a therapeutic advantage in the management of progressive renal insufficiency.
Insights
Calcium antagonists like nifedipine and nitrendipine effectively lower blood pressure in chronic renal failure patients. These drugs reduce renal vascular resistance without negatively impacting glomerular filtration rate or renal plasma flow.
Area of Science:
- Nephrology
- Pharmacology
- Cardiovascular Medicine
Background:
- Pharmacological manipulation of glomerular hemodynamics may influence chronic renal insufficiency and scarring.
- Calcium antagonists are potential agents for managing renal conditions.
Purpose of the Study:
- To investigate the short-term renal hemodynamic effects of nifedipine and nitrendipine in patients with chronic renal failure (CRF).
Main Methods:
- Two groups of 6 stable CRF patients received nifedipine or nitrendipine (10 mg thrice daily) for 4 weeks.
- Renal hemodynamics, including mean arterial pressure, GFR, and ERPF, were assessed before, during, and after treatment.
Main Results:
- Both nifedipine and nitrendipine significantly reduced mean arterial pressure.
- No significant changes were observed in GFR, effective renal plasma flow (ERPF), proteinuria, or natriuresis.
- Renal vascular resistance (RVR) decreased significantly in both treatment groups.
Conclusions:
- Calcium antagonists effectively lower systemic blood pressure in CRF patients while maintaining GFR and ERPF.
- The reduction in RVR suggests a potential therapeutic advantage for calcium antagonists in managing progressive renal insufficiency.