From the Guidelines
Hydralazine should be used with caution in patients with Acute Kidney Injury (AKI), as there is no clear evidence to support its safe use in this context.
Key Considerations
- The provided evidence does not specifically mention hydralazine, but it does discuss the importance of avoiding nephrotoxic medications in patients with AKI or Acute Kidney Disease (AKD) 1.
- When considering the use of any medication in AKI, it is essential to assess the risk-benefit ratio, taking into account the potential for nephrotoxicity and the availability of suitable alternatives 1.
- The selection and dosing of drugs in patients with AKI require dynamic assessments, considering factors such as changes in drug clearance, pharmacokinetic parameters, and the mechanism of nephrotoxicity 1.
- In general, ACE inhibitors and ARBs should be used with caution in patients with AKI, as they can cause hypotension and decreased filtration fraction, which can exacerbate AKI 1.
- The decision to use hydralazine in AKI should be made on a case-by-case basis, considering the individual patient's renal function, volume status, and overall clinical condition.
- It is crucial to monitor renal function and adjust medication dosing as needed to minimize the risk of nephrotoxicity and ensure optimal patient outcomes.
From the FDA Drug Label
In hypertensive patients with normal kidneys who are treated with hydrALAZINE, there is evidence of increased renal blood flow and a maintenance of glomerular filtration rate. ... However, as with any antihypertensive agent, hydrALAZINE should be used with caution in patients with advanced renal damage.
Hydralazine can be used with caution in patients with renal impairment, but its use in Acute Kidney Injury (AKI) is not directly addressed. However, given the warning to use with caution in patients with advanced renal damage, it is reasonable to exercise caution when considering its use in AKI. 2
From the Research
Administration of Hydralazine in Acute Kidney Injury (AKI)
- Hydralazine has been studied for its potential renoprotective effects in AKI, with some evidence suggesting it may attenuate renal inflammation and prevent the transition of AKI to chronic kidney disease (CKD) 3, 4.
- The drug has been shown to exert antioxidant, anti-inflammatory, and anti-fibrotic effects in both in vitro and in vivo studies, which may contribute to its potential benefits in AKI 3, 4.
- However, there are also reports of hydralazine-associated adverse events, including ANCA vasculitis and pauci-immune glomerulonephritis, which can lead to severe AKI and CKD 5, 6.
Considerations for Use in AKI
- The use of hydralazine in AKI should be carefully considered due to the potential risk of adverse events, particularly in patients with pre-existing kidney disease or those taking other medications that may interact with hydralazine 5, 6.
- More research is needed to fully understand the effects of hydralazine in AKI and to determine its potential role in the treatment of this condition 3, 4.
- Other vasopressor drugs, such as norepinephrine, may be safer and more effective in restoring blood pressure and urine output in patients with AKI, although the optimal treatment approach remains unclear 7.