From the Guidelines
The antihypertensive of choice for Acute Kidney Injury (AKI) is terlipressin, which should be started at a dose of 2 mg/day as a continuous IV infusion, in combination with albumin at a dose of 1 g/kg on day 1 of therapy followed by 40-50 g/day. This recommendation is based on the most recent and highest quality study available, which demonstrated that terlipressin, in combination with albumin, is associated with a higher likelihood of reversal of HRS and 10-day survival without RRT compared with placebo 1.
Key Considerations
- The use of terlipressin in AKI is supported by multiple studies, including a large randomized, placebo-controlled trial that showed a significant improvement in renal function and short-term survival 1.
- The dose of terlipressin should be adjusted based on the patient's response, with a maximum dose of 12 mg/day 1.
- Albumin should be administered in conjunction with terlipressin to maintain a central venous pressure between 4 and 10 mm Hg 1.
- Norepinephrine can be used as an alternative to terlipressin in patients who do not respond to terlipressin or in countries where terlipressin is not available, at a dose of 0.5-3.0 mg/h continuous IV infusion to increase MAP by 10 mmHg 1.
Monitoring and Adjustments
- Patients should be closely monitored for side effects, including abdominal pain, ischemia, and pulmonary edema, and the dose of terlipressin should be adjusted accordingly 1.
- Renal function and electrolytes should be closely monitored, and the dose of terlipressin and albumin should be adjusted based on the patient's response 1.
- The goal of treatment is to improve renal function and prevent further deterioration, while minimizing the risk of side effects and complications 1.
From the FDA Drug Label
DOSAGE AND ADMINISTRATION Hypertension Therapy should be individualized according to the patient's response to gain maximal therapeutic response and to determine the minimal dose needed to maintain the therapeutic response. Adults The usual initial dose of Furosemide tablets for hypertension is 80 mg, usually divided into 40 mg twice a day.
The antihypertensive of choice is not explicitly stated for Acute Kidney Injury (AKI) in the provided drug label. However, for hypertension, the drug of choice mentioned is Furosemide, with a starting dose of 80 mg, usually divided into 40 mg twice a day.
- Key points:
- The label does not directly address AKI.
- Furosemide is used for hypertension.
- Starting dose for hypertension is 80 mg, divided into 40 mg twice a day 2.
From the Research
Antihypertensive Treatment for Acute Kidney Injury (AKI)
The management of hypertension in patients with AKI is crucial, and the choice of antihypertensive agent is important.
- According to 3, the combination of furosemide and spironolactone may be a suitable option, as it produced only approximately a third of the risk of AKI as the combination of hydrochlorothiazide and spironolactone.
- However, 4 suggests that diuretics are ineffective and even detrimental in the prevention and treatment of AKI, and neither shorten the duration of AKI, nor reduce the need for renal replacement therapy.
Starting Dose of Antihypertensive for AKI
There is limited information available on the starting dose of antihypertensive agents for AKI.
- None of the studies provided 5, 6, 3, 7, 4 mention a specific starting dose for antihypertensive agents in the treatment of AKI.
Considerations for Antihypertensive Treatment in AKI
When treating hypertension in patients with AKI, it is essential to consider the following:
- The underlying cause of AKI, as well as the presence of any comorbidities, such as chronic kidney disease or poor cardiac function 3.
- The potential risks and benefits of different antihypertensive agents, including diuretics, in the management of AKI 4.
- The importance of careful fluid management and monitoring of blood pressure to avoid hypotensive episodes 6.