From the Guidelines
Micardis (telmisartan) is a recommended treatment for patients with chronic kidney disease (CKD) as it provides renoprotective effects beyond blood pressure control, as evidenced by the KDIGO 2020 clinical practice guideline for diabetes management in CKD 1. The use of angiotensin receptor blockers (ARBs) like telmisartan has been shown to reduce the risk of progression of CKD, with a dose-dependent reduction in the risk of progression, as seen in the IRMA-2 study 1. Key benefits of Micardis for CKD patients include:
- Reduced risk of progression to severely increased albuminuria
- Delayed progression to overt nephropathy
- Reduced incidence of doubling of serum creatinine and end-stage kidney disease (ESKD)
- Renoprotective effects independent of blood pressure control The typical dosage of Micardis for CKD patients ranges from 20-80 mg once daily, with 40 mg being a common starting dose. It is essential to monitor kidney function and potassium levels regularly while taking Micardis, especially when starting treatment or adjusting doses, as it can cause elevated potassium levels as a side effect 1. Overall, Micardis is a valuable treatment option for CKD patients, particularly those with hypertension or diabetes, as it provides kidney protection beyond just blood pressure control, as supported by the KDIGO 2020 guideline 1.
From the FDA Drug Label
5.5 Impaired Renal Function As a consequence of inhibiting the renin-angiotensin-aldosterone system, anticipate changes in renal function in susceptible individuals. In patients whose renal function may depend on the activity of the renin-angiotensin-aldosterone system (e.g., patients with severe congestive heart failure or renal dysfunction), treatment with angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor antagonists has been associated with oliguria and/or progressive azotemia and (rarely) with acute renal failure and/or death. Similar results have been reported with telmisartan [see Clinical Pharmacology (12.3)].
Telmilo (Telmisartan) and CKD: In patients with Chronic Kidney Disease (CKD), telmisartan may cause changes in renal function.
- Key considerations:
- Patients with severe congestive heart failure or renal dysfunction may be at higher risk.
- Treatment with telmisartan may be associated with oliguria, progressive azotemia, and rarely, acute renal failure or death.
- Monitoring of renal function and electrolytes is recommended, particularly in patients at risk.
- The use of telmisartan in patients with unilateral or bilateral renal artery stenosis has not been extensively studied, but similar effects to ACE inhibitors can be anticipated. 2
From the Research
Micardis and CKD
- Micardis, also known as telmisartan, is an angiotensin receptor blocker (ARB) that has been shown to be effective in reducing proteinuria and slowing the progression of chronic kidney disease (CKD) 3, 4, 5.
- The use of ARBs, such as telmisartan, has been recommended as a first-line treatment for patients with CKD, particularly those with hypertension and/or diabetes, due to their ability to provide renoprotection and reduce the risk of cardiovascular disease 4, 6.
- Studies have demonstrated that telmisartan can effectively reduce blood pressure and proteinuria in patients with CKD, even in those with advanced disease 3, 5.
- The optimal blood pressure target for patients with CKD is less than 130/80 mmHg, or 125/75 mmHg if the amount of urinary protein is more than 1 g/day 7, 6.
- Telmisartan has been shown to be well-tolerated and safe in patients with CKD, although monitoring for hyperkalemia is recommended 3, 5.