From the Guidelines
**Cilostazol should be used with caution in patients with chronic kidney disease (CKD), and its use is generally not recommended in severe CKD (eGFR <30 mL/min/1.73m²) due to limited safety data and potential accumulation of active metabolites**. For patients with mild to moderate CKD (eGFR >30 mL/min/1.73m²), the standard dose of 100 mg twice daily can typically be used without adjustment, as supported by the ACC/AHA 2005 practice guidelines for the management of patients with peripheral arterial disease 1. Cilostazol works by inhibiting phosphodiesterase type III, which increases cAMP levels, inhibits platelet aggregation, and causes vasodilation. While cilostazol is primarily metabolized by the liver with minimal renal excretion of the parent compound, its active metabolites are partially eliminated by the kidneys, which explains the concern in advanced kidney disease.
Some key points to consider when using cilostazol in CKD patients include:
- Regular monitoring of kidney function is important when using cilostazol in CKD patients
- The medication should be discontinued if kidney function significantly worsens or if intolerable side effects develop, such as headache, diarrhea, dizziness, and palpitations
- If cilostazol must be used in severe CKD, consider reducing the dose to 50 mg twice daily with careful monitoring for side effects
- Cilostazol has been shown to improve maximal walking distance by 40% to 60% compared with placebo after 12 to 24 weeks of therapy in patients with intermittent claudication, as reported in the ACC/AHA guidelines 1.
It is essential to weigh the potential benefits of cilostazol against the potential risks in patients with CKD, and to carefully monitor these patients for any adverse effects. The ACC/AHA guidelines provide a framework for the management of patients with peripheral arterial disease, including those with CKD 1.
From the Research
Cilostazol and Chronic Kidney Disease (CKD)
- Cilostazol is a medication that has been studied in the context of CKD, particularly in relation to its effects on platelet reactivity and cardiovascular risk 2.
- A study published in 2011 found that adjunctive cilostazol improved platelet inhibition compared to high-maintenance doses of clopidogrel in CKD patients undergoing hemodialysis 2.
- However, the primary focus of the available evidence is on pentoxifylline, a different medication, and its potential renoprotective effects in CKD patients 3, 4, 5, 6.
- Pentoxifylline has been shown to reduce proteinuria and slow renal disease progression in some studies 3, 4, 5, 6.
- The evidence on cilostazol and CKD is limited, and more research is needed to fully understand its effects on renal outcomes and cardiovascular risk in this patient population.
Key Findings on Pentoxifylline and CKD
- Pentoxifylline may have renoprotective effects, including reducing proteinuria and slowing renal disease progression 3, 4, 5, 6.
- A 2019 study found that long-term treatment with pentoxifylline reduced renal events and cardiovascular mortality in CKD patients 6.
- Another study published in 2015 found that pentoxifylline decreased the risk of end-stage renal disease in patients with advanced CKD 4.
- However, the evidence on pentoxifylline and CKD is not directly relevant to the question of cilostazol and CKD, and more research is needed to fully understand the effects of cilostazol on renal outcomes and cardiovascular risk in this patient population.
Platelet Reactivity and Cilostazol in CKD
- A 2011 study found that adjunctive cilostazol improved platelet inhibition compared to high-maintenance doses of clopidogrel in CKD patients undergoing hemodialysis 2.
- The study suggested that cilostazol may be a useful adjunctive therapy for reducing platelet reactivity and cardiovascular risk in CKD patients 2.
- However, more research is needed to fully understand the effects of cilostazol on platelet reactivity and cardiovascular risk in CKD patients, and to determine its potential role in the management of this patient population.