Does valsartan (angiotensin II receptor antagonist) affect renal function?

From the Guidelines

Valsartan can be beneficial for renal function in patients with kidney problems, as it slows the decrease in glomerular filtration rate (GFR) and urine volume, as shown in a study where 40 to 80 mg/d of valsartan was associated with a slower decrease in GFR and urine volume at 24 months, without a difference in blood pressure 1.

Key Points to Consider

• Valsartan, an angiotensin II receptor blocker (ARB), is recommended for patients with residual kidney function (RKF) who need antihypertensive medication, as it helps preserve RKF 1.
• The use of ACE inhibitors or ARBs, such as valsartan, is associated with a decrease in the slope of decline in kidney function in patients with kidney disorders, particularly those with diabetic kidney disease or glomerulonephritis 1.
• A study found that patients administered valsartan had a slower decrease in GFR and urine volume, without a difference in blood pressure, suggesting that the beneficial effect of valsartan on renal function may be independent of its blood pressure-lowering effect 1.
• Regular monitoring of kidney function and electrolytes is essential, particularly in the first few weeks of treatment and after dose adjustments, to minimize the risk of adverse effects such as acute kidney injury, increases in creatinine and potassium levels 1.

Important Considerations for Clinical Practice

• Patients with severe kidney impairment (GFR <30 mL/min) or bilateral renal artery stenosis should use valsartan with extreme caution or avoid it altogether, due to the increased risk of adverse effects 1.
• The dosage of valsartan should be carefully selected, with typical ranges from 80-320 mg once daily, and lower starting doses (40-80 mg) recommended for patients with impaired kidney function 1.
• Combination with other medications that affect kidney function, such as NSAIDs, should be avoided or used with caution, as it may increase the risk of adverse effects 1.

From the FDA Drug Label

There is no apparent correlation between renal function (measured by creatinine clearance) and exposure (measured by AUC) to valsartan in patients with different degrees of renal impairment (down to creatinine clearance of 10 mL/min). Valsartan is not removed from the plasma by hemodialysis

Valsartan does not appear to significantly affect renal function, as there is no apparent correlation between renal function and exposure to valsartan in patients with different degrees of renal impairment. Additionally, valsartan is not removed from the plasma by hemodialysis, suggesting that it does not rely heavily on renal clearance 2.

• Key points:
  • No apparent correlation between renal function and exposure to valsartan
  • Valsartan is not removed from the plasma by hemodialysis
  • Renal clearance of valsartan is about 0.62 L/h (about 30% of total clearance)

From the Research

Effects of Valsartan on Renal Function

• Valsartan, an angiotensin II receptor antagonist, has been studied for its effects on renal function in various patient populations, including those with chronic kidney disease (CKD) and heart failure with preserved ejection fraction (HFpEF) 3, 4, 5, 6, 7.
• A study published in the European journal of pharmacology found that Sacubitril/Valsartan could more effectively slow down renal function decline and reverse myocardial remodeling in patients with CKD and HFpEF than ACEI/ARB, even at low doses 3.
• However, another study reported a case of severe acute interstitial nephritis induced by valsartan, highlighting the potential for valsartan to cause severe kidney injury in rare cases 4.
• A pilot study published in Transplantation proceedings found that valsartan reduced blood pressure and proteinuria in patients with chronic renal allograft nephropathy without inducing a serious worsening in renal function 5.
• A systematic review and meta-analysis published in ESC heart failure found that sacubitril/valsartan resulted in a lower risk of renal dysfunction as compared with RAS inhibitors alone, with a stronger association found in studies including older patients or HF patients with preserved ejection fraction 6.
• The Kanagawa Valsartan Trial (KVT) found that the addition of valsartan to conventional therapy significantly slowed the rate of renal function decline and delayed the need for renal replacement therapy in Japanese hypertensive patients with advanced CKD 7.

Key Findings

• Valsartan may slow down renal function decline and reduce proteinuria in patients with CKD and HFpEF 3, 5, 7.
• Valsartan may cause severe kidney injury in rare cases, such as acute interstitial nephritis 4.
• Sacubitril/valsartan may have a protective effect on renal function, especially in older patients and HF patients with preserved ejection fraction 6.