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Calcium channel blockade and renal function
Insights
Calcium channel blockers improve renal function in acute studies, but long-term effects and impact on renin release require further investigation. Pharmacokinetics vary between drugs in patients with renal disease.
Area of Science:
- Nephrology
- Pharmacology
- Cardiovascular Medicine
Background:
- Calcium channel blockers (CCBs) are used to treat hypertension.
- Their effects on renal function are a significant clinical consideration.
- Existing research primarily focuses on acute effects, with limited data on long-term renal impacts.
Purpose of the Study:
- To review the renal effects of calcium channel blocking agents.
- To investigate their influence on renal hemodynamics and electrolyte excretion.
- To examine effects on renin release and pharmacokinetics in renal impairment.
Main Methods:
- Review of animal and human studies on CCBs and renal function.
- Analysis of acute and long-term clinical data.
- Examination of pharmacokinetic studies in patients with renal disease.
Main Results:
- Animal and acute human studies show CCBs increase renal blood flow, glomerular filtration rate, urine flow, and electrolyte excretion.
- Long-term clinical data on renal effects are lacking.
- Acute studies show increased renin release; long-term studies show no change in plasma renin levels.
- Verapamil pharmacokinetics are altered in uremic patients (smaller volume of distribution, decreased clearances).
- Nifedipine pharmacokinetics remain similar in uremic and normal subjects.
Conclusions:
- CCBs demonstrate beneficial acute renal effects.
- Further long-term studies are needed to fully understand their renal impact.
- Pharmacokinetic profiles of CCBs differ in patients with renal impairment, necessitating individualized treatment approaches.
Abstract:
Since calcium channel blocking agents were introduced into the treatment of hypertension their influence on renal function has become an important issue. In animal experiments calcium channel blocking agents have been shown to increase renal blood flow and glomerular filtration rate and to augment urine flow and electrolyte excretion. In human acute studies the administration of calcium channel blocking agents have elicited similar renal hemodynamic and diuretic effects. Clinical studies on the renal effects of long-term treatment are however still lacking. Studies on the effect on renin release have given divergent results. In acute experiments renin release is increased by calcium channel blocking agents. In long-term treatment, however, no change in peripheral plasma levels of renin has been demonstrated. The influence of decreased renal function on the pharmacokinetics of calcium channel blocking agents has been studied in patients with renal disease. For verapamil the volume of distribution is smaller in uremic patients than in normals and both metabolic and renal clearances are decreased. For nifedipine, on the other hand, similar plasma levels, plasma half life and total plasma clearance are found in uremic patients and normal subjects.