Skip to main content
SpringerLink
Log in
Book cover

Angiotensin II Receptor Blockade Physiological and Clinical Implications pp 87–91Cite as

Angiotensin II Receptor Antagonists in Patients With Renal Failure and on Hemodialysis

  • Chapter

  • 113 Accesses

Part of the book series: Progress in Experimental Cardiology ((PREC,volume 2))

Summary

Limited experience with the use of the angiotensin II antagonist losartan demonstrated good antihypertensive efficacy in patients with renal impairment irrespective of the degree of renal function. In milder forms of renal impairment, there was no further impairment of renal function and no accumulation of the parent drug or the active metabolite. It has been suggested that this is due to losartan being excreted via the hepatic as well as the renal route and that the former possibly compensates for a reduced renal excretion of the drug. Even though losartan is not dialysable, this feature makes it possible to use the drug in patients on hemodialysis. Angiotensin II antagonists may be useful as an alternative treatment in patients with renal impairment, patients who are on hemodialysis and do not tolerate ACE inhibitors, or patients who have a contraindication to this class of drugs. However there is still insufficient data available on the use of losartan in more severe forms of renal impairment.

This is a preview of subscription content, log in via an institution.

Chapter
USD   29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD   259.00
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD   329.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD   329.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Learn about institutional subscriptions

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Timmermans PB, Wong PC, Chiu AT, Herblin WF, Benfield P, Carini DJ, Lee RJ, Wexler RR, Saye JM, Smith RD. 1993. Angiotensin II receptors and angiotensin II receptor antagonists. Pharmacol Rev 45:205–251.

    PubMed  CAS  Google Scholar 

  2. Lacourciere Y, Lefebre J. 1995. Modulation of the renin-angiotensin-aldosterone system and cough. Can J Cardiol 11(Suppl F):33F–39F.

    PubMed  CAS  Google Scholar 

  3. Varonier HS, Panzani R. 1968. The effect of inhalations of bradykinin on healthy and atopic (asthmatic) children. Int Arch Allergy Immunol 34:293–296.

    Article  CAS  Google Scholar 

  4. Brenner BM, Meyer TW, Hostetter TH. 1982. Dietary protein intake and the progressive nature of kidney disease: The role of hemodynamically mediated glomerular injury in the pathogenesis of progressive glomerular sclerosis in aging, renal ablation and intrinsic renal disease. N Engl J Med 307:652–659.

    Article  PubMed  CAS  Google Scholar 

  5. Yoshida Y, Fogo A, Ichikawa I. 1989. Glomerular hemodynamic changes vs. hypertrophy in experimental glomerular sclerosis. Kidney Int 35:654–660.

    Article  PubMed  CAS  Google Scholar 

  6. Riser B, Cortes P, Zhao X, Bernstein J, Dumler F, Narins RG. 1992. Intraglomerular pressure and mesangial stretching stimulate extracellular matrix formation in the rat. J Clin Invest 90:1932–1943.

    Article  PubMed  CAS  Google Scholar 

  7. Arai M, Wada A, Isaka Y, Agaki Y, Sugiura T, Miyazaki M, Moriyama T, Yasufumi K, Naruse K, Naruse M, Yoshimasa O, Ando A, Kamada T, Ueda N, Imai E. 1995. In vivo transfection of genes for renin and angiotensinogen into the glomerular cells induced phenotypic change of the mesangial cells and glomerular sclerosis. Biochem Biophys Res Comm 206:525–532.

    Article  PubMed  CAS  Google Scholar 

  8. Lewis EJ, Hunsicker LG, Bain RP, Rohde RD. 1993. The effect of angiotensin converting enzyme inhibition on diabetic nephropathy. N Engl J Med 329:1456–1462.

    Article  PubMed  CAS  Google Scholar 

  9. Apperloo AJ, de Zeeuw D, de Jong PE. 1994. Short-term antiproteinuric response to antihypertensive treatment predicts long-term GFR decline in patients with non-diabetic renal disease. Kidney Int 45:S174–S178.

    CAS  Google Scholar 

  10. Remuzzi C, Bertani T. 1990. Is glomerulosclerosis a consequence of altered glomerular permeability to macromolecules? Kidney Int 38:384–394.

    Article  PubMed  CAS  Google Scholar 

  11. Gansevoort RT, de Zeeuw D, de Jong PE. 1993. Long-term benefits of the antiproteinuric effect of angiotensin converting enzyme inhibition in non-diabetic renal disease. Am J Kidney Dis 22:202–206.

    PubMed  CAS  Google Scholar 

  12. Kasiske BL, Kalil RSN, MA JZ, Liao M, Keane WF. 1993. Effect of antihypertensive therapy on the kidney in patients with diabetes: a meta-regression analysis. Ann Intern Med 118:129–138.

    Article  PubMed  CAS  Google Scholar 

  13. Maschio G, Alberti D, Janin G, Locatelli F, Mann JFE, Maschio G, Alberti D, Janin G, Locatelli F, Mann JFE, Motolese M, Ponticelli C, Ritz E, Zucchelli P. 1996. Effect of the angiotensin-converting-enzyme inhibitor benazepril on the progression of chronic renal insufficiency. N Engl J Med 334:939–945.

    Article  PubMed  CAS  Google Scholar 

  14. Kon V, Fogo A, Ichikawa I. 1993. Bradykinin causes selective efferent arteriolar dilation during angiotensin II converting enzyme inhibition. Kidney Int 44:545–550.

    Article  PubMed  CAS  Google Scholar 

  15. Gansevoort RT, de Zeeuw D, de Jong PE. 1994. Is the antiproteinuric effect of ACE inhibition mediated by interference in the renin-angiotensin system? Kidney Int 5:861–867.

    Article  Google Scholar 

  16. Ichikawa I. 1996. Will angiotensin II receptor antagonists be renoprotective in humans? Kidney Int 50:684–692.

    Article  PubMed  CAS  Google Scholar 

  17. Lafayette RA, Mayer G, Park SK, Meyer TW. 1992. Angiotensin II receptor blockade limits glomerular injury in rats with reduced renal mass. J Clin Invest 90:766–771.

    Article  PubMed  CAS  Google Scholar 

  18. Ziai F, Ots M, Provoost AP, Troy JL, Rennke HG, Brenner BM, Mackenzie HS. 1996. The angiotensin receptor antagonist, irbesartan, reduces renal injury in experimental chronic renal failure. Kidney Int 50(Suppl 57):S132–S136.

    Google Scholar 

  19. Heller J, Kramer HJ, Cervenka L, Hellerova S. 1996. Losartan protects the rat kidney from ischemic injury. Kidney Int 49(Suppl 55):S113–S114.

    Google Scholar 

  20. Goldberg AI, Dunlay MC, Sweet SC. 1995. Safety and tolerability of losartan potassium, an angiotensin II receptor antagonist, compared with hydrochlorothiazide, atenolol, felodipine ER, and angiotensin converting enzyme inhibitors for the treatment of systemic hypertension. Am J Cardiol 75:793–795.

    Article  PubMed  CAS  Google Scholar 

  21. Shaw W, Keane W, Sica D, Halstenson C, Gehr T, Marshall C, Lipschutz K, Shahinfar S. 1993. Safety and antihypertensive effects of losartan (MK-954; DUP 753), a new angiotensin II receptor antagonist, in patients with hypertension and renal disease (abstract). Clin Pharmacol Ther 53:140.

    Google Scholar 

  22. Shaw W, Snavely D. 1994. Safety and efficacy of losartan (DuP 753, MK 954) in hypertensive patients with renal impairment (abstract) J. Am Soc Nephrol 5:567.

    Google Scholar 

  23. Lo MW, Shahinfar S, Furtek CL, Ritter M, Shaw WC, Gehr T, Sica D, Halstenson C, Keane W. 1993. Pharmacokinetics of losartan (MK 954 and DuP 753) in patients with renal insufficiency. Clin Pharmacol Ther 53:160.

    Google Scholar 

  24. Johnston CI. 1995. Angiotensin receptor antagonists: focus on losartan. Lancet 346:1403–1407.

    Article  PubMed  CAS  Google Scholar 

  25. Telemans C, Madhoun P, Lenaers M, Schandene L, Goldman M, Vanherweghem JL. 1990. Anaphylactoid reactions during hemodialysis on AN69 membranes in patients receiving ACE inhibitors. Kidney Int 38:982–984.

    Article  Google Scholar 

  26. Verresen L, Fink E, Lemke H-D, Vanrenterghem Y. 1994. Bradykinin is a mediator of anaphylactoid reactions during hemodialysis with AN69 membranes. Kidney Int 45:1497–1503.

    Article  PubMed  CAS  Google Scholar 

  27. Acker CG, Greenberg A 1995. Angioedema induced by the angiotensin II blocker losartan. N Engl J Med 333:1572.

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Health Sciences Centre, University of Manitoba, Winnipeg, Manitoba, Canada

    Donald Allan & Peter Bolli

Authors
  1. Donald Allan
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Peter Bolli
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

  1. Institute of Cardiovascular Sciences St. Boniface General Hospital Research Centre Faculty of Medicine, University of Manitoba, Winnipeg, Canada

    Naranjan S. Dhalla Ph.D., M.D. (Hon.) (Distinguished Professor and Director MRC Group in Experimental Cardiology), Peter Zahradka Ph.D. (Associate Professor), Ian M. C. Dixon Ph.D. (Assistant Professor) & Robert E. Beamish M.D. (Professor Emeritus) (Distinguished Professor and Director MRC Group in Experimental Cardiology),  (Associate Professor),  (Assistant Professor) &  (Professor Emeritus)

Rights and permissions

Reprints and permissions

Copyright information

© 1998 Springer Science+Business Media New York

About this chapter

Cite this chapter

Allan, D., Bolli, P. (1998). Angiotensin II Receptor Antagonists in Patients With Renal Failure and on Hemodialysis. In: Dhalla, N.S., Zahradka, P., Dixon, I.M.C., Beamish, R.E. (eds) Angiotensin II Receptor Blockade Physiological and Clinical Implications. Progress in Experimental Cardiology, vol 2. Springer, Boston, MA. https://doi.org/10.1007/978-1-4615-5743-2_7

Download citation

  • DOI: https://doi.org/10.1007/978-1-4615-5743-2_7

  • Publisher Name: Springer, Boston, MA

  • Print ISBN: 978-1-4613-7631-6

  • Online ISBN: 978-1-4615-5743-2

  • eBook Packages: Springer Book Archive

Publish with us

Policies and ethics

Search

Navigation