From the Guidelines
Lisinopril is not considered more nephrotoxic than losartan, as both medications are renoprotective and often used to treat hypertension and protect kidney function in patients with chronic kidney disease. The evidence from the American Journal of Kidney Diseases 1 suggests that angiotensin converting enzyme inhibitors (ACEi) or angiotensin receptor blockers (ARBs) are favored over other medication classes for improvement of renal outcomes in non-dialysis-dependent chronic kidney disease (NDD-CKD) patients, particularly in those with albuminuria. Some key points to consider when prescribing these medications include:
- Starting with a low dose and titrating up as needed while monitoring kidney function
- Regular monitoring of serum creatinine and potassium levels
- Being aware of potential side effects, such as a dry cough with ACE inhibitors like lisinopril, which may necessitate switching to an ARB like losartan
- Avoiding dual blockade of the renin-angiotensin-aldosterone (RAAS) system, as it has been shown to increase the risk of adverse events, including serum creatinine doubling and hyperkalemia, without improving hard outcomes in NDD-CKD patients 1. Overall, the choice between lisinopril and losartan should be based on individual patient factors, such as tolerability and side effect profile, rather than concerns about nephrotoxicity.
From the Research
Nephrotoxicity Comparison
- The available evidence does not provide a direct comparison of the nephrotoxicity of lisinopril and losartan in a single study 2, 3, 4, 5, 6.
- However, studies suggest that both lisinopril and losartan can cause renal dysfunction in certain patients, particularly those with underlying renal pathology or bilateral renal artery stenosis 2, 5.
- A study found that losartan-induced acute renal failure may occur in patients sensitive to reduced renal plasma flow, similar to ACE inhibitors like lisinopril 2.
- Another study reported a case of acute renal failure during combined therapy with lisinopril and losartan, emphasizing the need for close surveillance of renal function and blood pressure during such therapy 5.
- Lisinopril has been shown to be effective in reducing blood pressure and preserving renal function in patients with diabetes, but its use requires careful monitoring of renal function, especially in patients with severe renal impairment 3, 6.
Renal Function Monitoring
- Renal function should be monitored in patients taking either lisinopril or losartan, especially in those with underlying renal dysfunction or other risk factors for renal disease 2, 5, 6.
- The available evidence suggests that both lisinopril and losartan can cause reversible renal dysfunction, which can be managed by discontinuing the offending agent and monitoring renal function closely 2, 5.