When can losartan (Angiotensin II Receptor Antagonist) be restarted after an episode of Acute Kidney Injury (AKI)?

From the Guidelines

Losartan should be restarted after acute kidney injury (AKI) only when kidney function has stabilized and improved, typically when serum creatinine returns to within 30% of baseline, as the risk-benefit ratio of its use in patients with AKD must be carefully considered and therapy personalized according to the individual risks of the patient 1. When considering the restart of losartan, several factors should be taken into account, including:

• The patient's baseline risk adjustment, such as comorbidities like chronic kidney disease (CKD) or congestive heart failure (CHF) 1
• The indication and alternatives for losartan use, as well as its mechanism of action and potential effects on renal function 1
• The availability of pharmacokinetic and pharmacodynamic data, and alterations in AKD 1
• The assessment of renal function using available biomarkers, including serum creatinine, proteinuria, and imaging techniques 1 The decision to restart losartan should be based on the individual patient's needs and circumstances, and should take into account the potential benefits and risks of its use in the context of AKD. Some key considerations when restarting losartan include:
• Starting at a lower dose, such as 25 mg daily, and monitoring kidney function closely with blood tests after 1-2 weeks 1
• Gradual dose titration based on blood pressure control and kidney function stability 1
• Ensuring the patient is adequately hydrated and avoiding concurrent use of other nephrotoxic medications like NSAIDs 1 It is essential to weigh the potential benefits of losartan against the risks, particularly in patients with conditions like heart failure, hypertension, or diabetic nephropathy, where the long-term benefits of losartan may outweigh the risks once kidney function stabilizes 1.

From the FDA Drug Label

The FDA drug label does not answer the question.

From the Research

Losartan Restart After Acute Kidney Injury

• There is no specific information available on when losartan can be restarted after acute kidney injury 2, 3, 4, 5, 6.
• However, studies suggest that losartan can be beneficial in reducing the risk of chronic kidney disease and mortality after acute kidney injury 4.
• Losartan has been shown to reduce inflammation and oxidative stress, and improve renal function in animal models of acute kidney injury 4, 5.
• The decision to restart losartan after acute kidney injury should be made on a case-by-case basis, taking into account the individual patient's condition and medical history.
• It is essential to monitor renal function and adjust the treatment plan accordingly 6.

Key Considerations

• Losartan can affect renal function, particularly in patients with pre-existing chronic renal failure or those taking diuretics 2.
• The use of losartan in patients with acute kidney injury requires careful monitoring of renal function and adjustment of the treatment plan as needed 3, 4, 5.
• Losartan may be beneficial in reducing the risk of chronic kidney disease and mortality after acute kidney injury, but more research is needed to confirm this 4.