From the Guidelines
Calcium channel blockers, particularly non-dihydropyridine calcium channel blockers, are recommended for patients with chronic kidney disease (CKD) as they can reduce proteinuria and slow CKD progression, as evidenced by studies such as 1.
Benefits of Calcium Channel Blockers in CKD
The benefits of calcium channel blockers in CKD patients include:
- Reducing proteinuria and slowing CKD progression, as shown in studies such as 1
- Lowering blood pressure without requiring dose adjustments in kidney impairment
- Not affecting potassium levels, making them a safe option for CKD patients
- Ability to be safely combined with ACE inhibitors or ARBs for enhanced renoprotection
- Helping to manage hypertension in diabetic nephropathy and reducing cardiovascular risk in CKD patients
Types of Calcium Channel Blockers
There are two main types of calcium channel blockers:
- Non-dihydropyridine calcium channel blockers, such as diltiazem and verapamil, which are recommended for CKD patients due to their ability to reduce proteinuria and slow CKD progression, as shown in studies such as 1
- Dihydropyridine calcium channel blockers, such as amlodipine, nifedipine, and felodipine, which are commonly prescribed for blood pressure control in CKD patients, but may not be as effective in reducing proteinuria and slowing CKD progression, as noted in studies such as 1
Monitoring and Side Effects
Regular monitoring of blood pressure, kidney function, and electrolytes is recommended when using calcium channel blockers in CKD patients. Common side effects include ankle edema, and non-dihydropyridine calcium channel blockers may interact with certain medications due to their metabolism through the CYP3A4 pathway, as noted in studies such as 1.
Treatment Goals
The treatment goal for blood pressure in CKD patients is less than 140/90 mm Hg, as recommended by the JNC-8 guidelines, as outlined in 1. It is essential to consider the individual patient's needs and medical history when selecting a calcium channel blocker and determining the treatment goal, as recommended by guidelines such as 1.
From the Research
Calcium Channel Blockers in Chronic Kidney Disease
- Calcium channel blockers (CCBs) are frequently used in combination with renin-angiotensin-aldosterone system inhibitors for CKD patients due to their strong BP-lowering properties and relatively few adverse side effects 2.
- CCBs have several subtypes, including L, N, T, P/Q, and R, and three types of CCBs, L-type CCBs, L-/T-type CCBs, and L-/N-type CCBs, that are available 2.
- The benefits of CCBs over other antihypertensives on predialysis blood pressure levels and intradialytic hypotension among people with CKD who required haemodialysis were uncertain 3.
- Dihydropyridine CCBs may decrease predialysis systolic and diastolic blood pressure level compared to placebo or no treatment 3.
- CCBs impair renal autoregulation, which protects glomerular capillaries against the transmission of systemic pressures, making them less effective than other antihypertensives in proteinuric nephropathies unless normotension is achieved 4.
- Non-DHP CCBs, including verapamil and diltiazem, have a mechanism of action that differs from DHP CCBs and could potentially attenuate sympathetic activity and reduce protein excretion in patients with CKD 5.
- Lercanidipine, a dihydropyridine calcium channel blocker, seems to provide renal protection in a similar way to ACE inhibitors, probably thanks to its mechanism of action which acts directly on the afferent and efferent renal arterioles 6.
Types of Calcium Channel Blockers
- L-type CCBs, L-/T-type CCBs, and L-/N-type CCBs are available for use in CKD patients 2.
- Dihydropyridine CCBs, such as amlodipine and nifedipine, are effective in reducing systemic hypertension but lack activity in reducing proteinuria or attenuating sympathetic activity 5.
- Non-DHP CCBs, including verapamil and diltiazem, have a different mechanism of action than DHP CCBs and may provide additional benefits in CKD patients 5.
Clinical Implications
- CCBs should be used with caution in CKD patients, taking into account their potential effects on renal autoregulation and proteinuria 4.
- The choice of CCB should be individualized based on the patient's specific needs and the potential benefits and risks of each agent 2, 6.
- Further research is needed to fully understand the effects of CCBs on CKD patients and to determine the optimal treatment strategies for this population 3, 6.