Can olmesartan (Angiotensin II Receptor Antagonist) cause Acute Kidney Injury (AKI)?

From the Guidelines

Olmesartan can cause acute kidney injury (AKI), particularly in patients with pre-existing kidney disease, bilateral renal artery stenosis, or those taking other medications that affect kidney function. The mechanism of olmesartan-induced AKI is related to its effects on renal hemodynamics, particularly in patients with volume depletion or severe heart failure 1. According to the American Heart Association, ACE inhibitors and ARBs, such as olmesartan, can reduce intravascular volume, renal blood flow, and/or glomerular filtration, leading to AKI 1. However, it is essential to note that small elevations in serum creatinine (up to 30% from baseline) with renin-angiotensin system (RAS) blockers, such as olmesartan, should not be confused with AKI, and these medications should not be discontinued for minor increases in serum creatinine (<30%) in the absence of volume depletion 1. Some key points to consider when prescribing olmesartan include:

• Monitoring serum creatinine and electrolyte levels before and after initiating therapy
• Avoiding the use of olmesartan in patients with bilateral renal artery stenosis or severe heart failure
• Discontinuing the medication if a patient develops unexplained diarrhea, weight loss, or declining kidney function
• Considering alternative antihypertensive therapy if olmesartan is discontinued due to AKI. It is crucial to weigh the benefits and risks of olmesartan therapy in patients with kidney disease, and to closely monitor their kidney function to minimize the risk of AKI 1.

From the FDA Drug Label

1. 4 Impaired Renal Function As a consequence of inhibiting the renin-angiotensin-aldosterone system, changes in renal function may be anticipated in susceptible individuals treated with olmesartan medoxomil. In patients whose renal function may depend upon the activity of the renin-angiotensin­-aldosterone system (e.g., patients with severe congestive heart failure), treatment with angiotensin converting enzyme (ACE) inhibitors and angiotensin receptor antagonists has been associated with oliguria and/or progressive azotemia and rarely with acute renal failure and/or death. Similar results may be anticipated in patients treated with olmesartan medoxomil
2. 2 Non-Steroidal Anti-Inflammatory Agents Including Selective Cyclooxygenase-2 Inhibitors (COX-2 Inhibitors) In patients who are elderly, volume-depleted (including those on diuretic therapy), or with compromised renal function, co-administration of NSAIDs, including selective COX-2 inhibitors, with angiotensin II receptor antagonists, including olmesartan medoxomil, may result in deterioration of renal function, including possible acute renal failure.

Yes, olmesartan can cause Acute Kidney Injury (AKI), particularly in susceptible individuals, such as those with severe congestive heart failure or compromised renal function, and when co-administered with certain medications like NSAIDs or other RAS inhibitors 2, 2.

• Key factors that increase the risk of AKI include:
  • Inhibition of the renin-angiotensin-aldosterone system
  • Pre-existing renal impairment
  • Concomitant use of NSAIDs or other RAS inhibitors
  • Volume depletion or salt depletion
• Monitoring of renal function is recommended in patients receiving olmesartan, especially in those with pre-existing renal impairment or when co-administered with other medications that may increase the risk of AKI.

From the Research

Olmesartan and Acute Kidney Injury (AKI)

• Olmesartan, an angiotensin II receptor blocker (ARB), has been associated with acute renal failure in patients with bilateral renal artery stenosis 3.
• The use of olmesartan requires caution and close follow-up of renal functions, especially in patients with risk factors such as renal artery stenosis 3.
• A study on drug-induced acute kidney injury found that angiotensin II receptor blockers, including olmesartan, can cause type A reactions, which are predictable and dose-dependent 4.
• However, another study found that olmesartan did not improve renal outcomes in type 2 diabetic patients with overt nephropathy, and was associated with a higher incidence of hyperkalaemia 5.
• Acute kidney injury is a complex condition with diverse pathophysiological mechanisms, and management in critical care settings is challenging 6.
• A case-noncase study of a pharmacovigilance database found that agents acting on the renin-angiotensin system, including ARBs like olmesartan, were among the most frequently implicated drug classes in acute kidney injury 7.

Key Findings

• Olmesartan can cause acute renal failure in patients with bilateral renal artery stenosis 3.
• Angiotensin II receptor blockers, including olmesartan, can cause type A reactions, which are predictable and dose-dependent 4.
• Olmesartan did not improve renal outcomes in type 2 diabetic patients with overt nephropathy 5.
• Agents acting on the renin-angiotensin system, including ARBs like olmesartan, are among the most frequently implicated drug classes in acute kidney injury 7.