Does clonidine cause Acute Kidney Injury (AKI)?

From the Guidelines

Clonidine does not typically cause acute kidney injury (AKI). Clonidine is an alpha-2 adrenergic agonist commonly used to treat hypertension, ADHD, and certain pain conditions, and it generally has a favorable renal safety profile 1. While clonidine can cause changes in blood pressure that might theoretically impact kidney function, direct nephrotoxicity is not a known or common side effect of this medication. In patients with pre-existing kidney disease or those who are volume depleted, the blood pressure-lowering effects of clonidine could potentially reduce renal perfusion, but this is not a direct toxic effect on the kidneys. More common side effects of clonidine include dry mouth, drowsiness, dizziness, constipation, and sedation. If a patient develops signs of AKI while taking clonidine, other causes should be investigated, such as dehydration, other medications, or underlying medical conditions. Patients with significant kidney disease should have their clonidine dosage adjusted appropriately, as the drug is partially eliminated by the kidneys.

Some key points to consider when evaluating the risk of AKI with clonidine include:

• The medication's pharmacological properties and potential effects on renal function
• The patient's underlying medical conditions, such as pre-existing kidney disease or volume depletion
• The presence of other medications that may increase the risk of AKI, such as nonsteroidal anti-inflammatory drugs (NSAIDs) or diuretics
• The importance of monitoring renal function and adjusting the clonidine dosage as needed to minimize the risk of AKI.

It is essential to note that the most recent and highest-quality study on this topic, published in 2022, does not mention clonidine as a medication that causes AKI 1. Therefore, based on the current evidence, clonidine is not typically associated with an increased risk of AKI. However, as with any medication, it is crucial to monitor patients for potential adverse effects and adjust the treatment plan accordingly.

From the FDA Drug Label

Renal blood flow and glomerular filtration rate remain essentially unchanged. The FDA drug label does not directly answer if clonidine causes Acute Kidney Injury (AKI), but it does mention that renal blood flow and glomerular filtration rate remain essentially unchanged.

• The label does not provide information on AKI as an adverse effect.
• Clonidine is primarily excreted by the kidneys, and its half-life increases in patients with severe renal impairment. However, based on the available information, it can be inferred that clonidine is not likely to cause AKI in patients with normal renal function, but this cannot be concluded with certainty due to the lack of direct information on AKI in the label 2.

From the Research

Clonidine and Acute Kidney Injury (AKI)

• The relationship between clonidine and AKI is complex and has been studied in various contexts.
• A study from 1980 3 found that clonidine did not cause deterioration of renal function in patients with primary hypertension, and it was effective in patients with renal hypertension with or without renal failure.
• Another study from 2014 4 found that clonidine did not alter the risk of acute kidney injury in patients undergoing noncardiac surgery.
• A study from 2019 5 found that clonidine had complex and dose-dependent effects on the cardiovascular, renal, and inflammatory responses to experimental bacteremia, but it did not directly address the question of whether clonidine causes AKI.
• A study from 1980 6 found that clonidine lessened renal failure and microvascular damage after renal ischemia in rabbits, suggesting a potential protective effect of clonidine on the kidneys.
• A protocol for a substudy of the Perioperative Ischaemic Evaluation (POISE) 2 randomised controlled trial 7 aimed to investigate the effects of aspirin and clonidine on acute kidney injury in non-cardiac surgery, but the results of this study are not provided in the available evidence.

Key Findings

• Clonidine does not appear to cause AKI in patients with primary hypertension 3.
• Clonidine does not alter the risk of AKI in patients undergoing noncardiac surgery 4.
• Clonidine may have protective effects on the kidneys after renal ischemia 6.
• The effects of clonidine on AKI are complex and may depend on the context and dosage 5.