From the Guidelines
Amlodipine should be used with caution in patients with acute kidney injury (AKI), particularly if they have hypotension or if the AKI is suspected to be caused by the medication itself, as it may exacerbate edema and have little impact on proteinuria 1. When considering the management of hypertension in the context of AKI, it's crucial to prioritize maintaining adequate blood pressure for kidney perfusion. Amlodipine, being a calcium channel blocker, is primarily eliminated through hepatic metabolism rather than renal excretion, which suggests that dose adjustments may not be necessary in kidney dysfunction 1. However, the most recent evidence from 2023 highlights the importance of careful consideration of antihypertensive medications in patients with glomerular disease, emphasizing the potential for dihydropyridine calcium channel blockers like amlodipine to exacerbate edema and possibly increase proteinuria 1.
Key considerations in the management of patients with AKI include:
- Monitoring blood pressure closely and adjusting antihypertensive medications as necessary to avoid hypotension, which can worsen kidney perfusion.
- Addressing volume depletion promptly, as it can contribute to AKI, and considering holding medications like ACE inhibitors or ARBs and diuretics in such scenarios 1.
- Reassessing all medications, including amlodipine, if AKI worsens despite appropriate management, considering the potential for these medications to impact kidney function and proteinuria.
- Being aware of the long half-life of amlodipine (30-50 hours), which means its effects can persist for several days after discontinuation, an important consideration when managing blood pressure during AKI episodes.
In the context of real-life clinical practice, prioritizing the patient's blood pressure management, volume status, and kidney function is essential. The decision to continue or discontinue amlodipine in a patient with AKI should be made on a case-by-case basis, taking into account the most recent and highest quality evidence available, such as the 2023 commentary on the management of glomerular diseases 1.
From the FDA Drug Label
In hypertensive patients with normal renal function, therapeutic doses of amlodipine resulted in a decrease in renal vascular resistance and an increase in glomerular filtration rate and effective renal plasma flow without change in filtration fraction or proteinuria
The use of amlodipine does not appear to have a direct negative effect on kidney function in patients with normal renal function. Amlodipine may even have a beneficial effect on renal function by decreasing renal vascular resistance and increasing glomerular filtration rate. However, there is no direct information in the provided drug label about the relationship between Amlodipine and Acute Kidney Injury (AKI). 2
From the Research
Amlodipine and Acute Kidney Injury (AKI)
- There are no direct studies on Amlodipine and Acute Kidney Injury (AKI) in the provided evidence.
- However, the studies provide information on the impact of angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) on AKI, which are relevant to the topic as Amlodipine is a calcium channel blocker often used in combination with ACEIs or ARBs.
- The studies suggest that ACEIs and ARBs may have a beneficial effect on mortality and progression to chronic kidney disease in patients with AKI 3, 4, 5.
- However, the use of ACEIs and ARBs may also increase the risk of hyperkalemia and acute kidney disease (AKD) in patients with AKI 3, 4.
- The management of AKI involves prompt workup of the underlying cause, optimization of volume status, and avoidance of nephrotoxic medications 6, 7.
- The optimal timing of renal replacement therapy in critically ill patients with AKI is unclear, but it is an area of active investigation 7.
- Patients with AKI are at an increased long-term risk of death, and effective strategies that improve long-term outcomes in patients with AKI are unknown 5.