High serum enalaprilat in chronic renal failure

Elung-Jensen, Thomas; Heisterberg, Jens; Kamper, Anne-Lise; Sonne, Jesper; Strandgaard, Svend; Larsen, Niels

doi:10.3317/jraas.2001.038

Cited by 8 publications

(6 citation statements)

References 37 publications

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“…< 10 ng ml −1 [6–8]. The choice of the high concentration level above 50 ng ml −1 was based upon observations in our previous cross‐sectional study [5]. A higher cut‐off value in the high concentration group was not deemed feasible out of safety concerns, because patients with only moderately impaired renal function might have needed more than the recommended maximum dose of enalapril (40 mg daily) to achieve that.…”

Section: Discussionmentioning

confidence: 99%

“…< 10 ng ml −1 [6–8]. The choice of the high concentration level> 50 ng ml −1 was based upon observations in our previous cross‐sectional study [5]. Randomization was done by the drawing of sealed envelopes after stratification by GFR above or below 15 ml min −1 .…”

Section: Methodsmentioning

confidence: 99%

“…Patients not on this treatment at baseline were given an initial dose of 2.5 mg enalapril daily. Adjustments of dose depended on renal function and were based on findings in our previous cross‐sectional study of enalaprilat concentrations in patients with chronic renal failure [5]. No patients were to be given more than 40 mg enalapril daily.…”

Section: Methodsmentioning

confidence: 99%

“…Thus, in a cross‐sectional study of 59 enalapril‐treated patients with chronic renal failure of various aetiology, 90% had higher serum concentrations of enalaprilat than reported in subjects with normal kidney function, and a marked elevation of serum enalaprilat was observed in patients with a glomerular filtration rate (GFR) below 30 ml min −1 . There was considerable interpatient variation in plasma concentrations of enalaprilat when patients with comparable renal function were equally dosed [5]. The clinical significance of such an accumulation is not known.…”

Section: Introductionmentioning

confidence: 99%

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Blood pressure response to conventional and low‐dose enalapril in chronic renal failure

Elung-Jensen

Heisterberg

Kamper

et al. 2003

Brit J Clinical Pharma

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AimsIn chronic renal failure, the clearance of most ACE inhibitors including enalapril is reduced. Hence, with conventional dosage, plasma enalaprilat may be markedly elevated. It is unclear whether this excess of drug exposure affords an improved control of blood pressure. The aim of the present study was to evaluate short-term blood pressure response to two different plasma levels of enalaprilat. Methods As part of an open, randomized, controlled trial of the effect of high and low dosage of enalapril on the progression of renal failure, short-term blood pressure response was evaluated. Data were analysed in all patients completing 3 months of follow-up. The patients were allocated to two trough plasma concentrations of enalaprilat, either above 50 ng ml -1 (high) ( n = 17) or below 10 ng ml -1 (low) ( n = 18), and the daily dose of enalapril titrated accordingly. Results Median (range) glomerular filtration rate (GFR) at baseline was 18 (7.9) in the high enalaprilat concentration group and 17 (7.3) ml min -1 1.73 m 2 in the low concentration group (NS). Nine patients in each group were on treatment with enalapril at baseline with a median daily dose of 5 mg in both the high (5-10) and low (2.5-20) concentration group. At 3 months' follow-up, the dose was 10 (2.5-30) and 1.9 (1.25-5) mg ( P < 0.0001), respectively. After 3 months median trough concentrations of enalaprilat were 82.5 (22-244) ng ml -1 and 9.1 (2.5-74.8) ng ml -1 ( P < 0.002). At baseline the median systolic blood pressures in the two groups were 140 (110-200) and 133 (110-165), in the high and low enalaprilat concentration groups, respectively, and after 3 months they were 135 (105-170) and 130 (105-170) mmHg (NS). Median diastolic blood pressure was 80 mmHg in each group both at baseline (65-100) and at follow-up (60-95) (NS). There was no difference between the groups in concomitant antihypertensive treatment (number of patients treated, mean daily dose) during the observation period. Proteinuria remained stable during the study period in both groups; patients in the high concentration group had higher plasma potassium concentrations at day 90 and patients in the low group experienced a slight increase in GFR. Conclusions In moderate to severe chronic renal insufficiency the same degree of blood pressure control was achieved on low as well as moderate daily doses of enalapril. This was irrespective of concomitant antihypertensive treatment.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Blood pressure response to conventional and low‐dose enalapril in chronic renal failure

Elung-Jensen

Heisterberg

Kamper

et al. 2003

Brit J Clinical Pharma

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“…A high proportion of renal failure among the elderly has been considered to engender reservations in prescribing ACE inhibitors for this patient group [26] . However, it is not appropriate to withhold ACE inhibitors for heart failure in patients with only mild renal failure [27,28] . Our findings show a low treatment rate in patients with adequate renal function as well.…”

Section: Heart Failure/probnpmentioning

confidence: 99%

Atrial fibrillation and heart failure in seven nursing homes

Krüger¹,

Sandli²,

Geitung³

et al. 2012

JNEP

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Objectives:

Previous research suggests that blood-thinning treatment for patients with atrial fibrillation as well as treatment for patients with heart failure is not adequate among the elderly. We tested this among long-term patients in nursing homes.

Methods: Information about the patients (n = 513) was collected during the period March-April 2008. Data collection consisted of electrocardiography, particulars of any stroke suffered and copying medication records. A standardized set of blood samples was analyzed.

Results: Of the 91 atrial fibrillation patients, 14.3% were anticoagulated with warfarin. 42.0% of the patients with atrial fibrillation had no form of antithrombotic treatment. Prevalence of atrial fibrillation was 18.8% and high B-type natriuretic peptide (ProBNP > 225 pmol/L) 13.2%. Of the patients with both stroke and atrial fibrillation, 24.3% were given warfarin. Of the 59 patients with ProBNP > 225 pmol/L and adequate renal function (eGFR > 50 ml/min), 22.0% were given ACE/A2B.

Conclusions: The warfarin treatment rate was lower than recommended for patients with atrial fibrillation in nursing homes, as was probably the use of ACE-inhibitors to heart -failure patients. We found significant differences between the nursing homes with regard to treatment rate. Atrial fibrillation and heart failure case finding and monitoring in nursing homes needs to be improved and simple tools like recording and reporting irregular pulse by doctors and nurses and measure ProBNP on a regular basis may improve this.

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High-Risk IV Medications in Special Patient Populations
Kane‐Gill¹,
Dasta²
2011
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High serum enalaprilat in chronic renal failure

Cited by 8 publications

References 37 publications

Blood pressure response to conventional and low‐dose enalapril in chronic renal failure

Blood pressure response to conventional and low‐dose enalapril in chronic renal failure

Atrial fibrillation and heart failure in seven nursing homes

High-Risk IV Medications in Special Patient Populations

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