Nitrendipine and amlodipine mimic the acute effects of enalapril on renal haemodynamics and reduce glomerular hyperfiltration in patients with chronic kidney disease

Abstract

Antihypertensive drugs may have an important effect on glomerular haemodynamics. In chronic nephropathy patients, we compared the effect on glomerular haemodynamics of two second-generation dihydropyridinic agents, nitrendipine and amlodipine, with a first generation dihydropyridinic agent and an ACE-inhibitor, enalapril. In all, 32 patients (pts), divided into four groups, received the different drugs: ENA (enalapril, eight pts), NIF (nifedipine, eight pts), NIT (nitrendipine, eight pts) AML (amlodipine, eight pts). The study assessed the effect on glomerular haemodynamics of a single administration of the test drug in baseline conditions and in glomerular hyperfiltration experimentally induced by amino-acid infusion. The glomerular filtration rate (GFR, measured by inulin clearance), effective renal plasma flow (ERPF, measured by p-aminohippurate clearance), renal vascular resistances (RVR) and filtration fraction (FF) were assessed. Administration of AML and NIT test dose reduced FF, as did ENA, but not NIF, in both baseline (AML: P ¼ 0.005; NIT: P ¼ 0.02; ENA: P ¼ 0.007) and glomerular hyperfiltration conditions (AML: P ¼ 0.0003; NIT: P ¼ 0.03; ENA: P ¼ 0.00006). In baseline conditions, only ENA resulted in a significant drop in the GFR (P ¼ 0.008), while NIF, NIT and AML induced a significant increase (P ¼ 0.003, 0.03, 0.0001, respectively). However, in hyperfiltration conditions, NIT (0.08) and AML (0.00003) caused a decrease in the GFR, as did ENA (0.0003) but not NIF. In all the experimental conditions, a RVR reduction and an ERPF increase were observed. Single dose of NIT and AML were effective in attenuating the effect of amino-acid infusion on glomerular filtration, similar to ENA; this effect of NIT and AML on the glomerular filtration rate is not observed under basal conditions.

Comparative Effect of Calcium Channel Blockers on Glomerular Function in Hypertensive Patients with Diabetes Mellitus

“…Although some studies have reported the effect of L/T-, L/N-, or L/N/T-type CCBs on estimated GFR (eGFR), their results vary according to concomitant drugs, treatment duration, and medical history of the patients [ 6 , 7 , 10 ]. In addition, some CCBs are known to cause an increase in GFR, hyperfiltration, and edema in the acute phase of initiation of treatment in patients with CKD [ 11 – 13 ]. Agodoa et al reported that eGFR increased during the first 3 months of treatment with amlodipine, an L-type CCB, but decreased after 36 months in patients without proteinuria [ 14 ].…”

Amlodipine Reduces Inflammation despite Promoting Albuminuria in the Streptozotocin-Induced Diabetic Rat

“…However, it is more likely that amlodipine raised GFR early in the disease and returned to normal levels after 12 weeks due to glomerular injury. Variable effects of CCBs on GFR have been reported in other models and humans [14, 17, 35]. In patients with chronic, nondiabetic renal disease and in patients with mild to moderate essential hypertension, amlodipine increased GFR and glomerular capillary pressure [35].…”

“…Variable effects of CCBs on GFR have been reported in other models and humans [14, 17, 35]. In patients with chronic, nondiabetic renal disease and in patients with mild to moderate essential hypertension, amlodipine increased GFR and glomerular capillary pressure [35]. In type 2 diabetic patients with hypertension and nephropathy a significant decrease in estimated GFR was observed after treatment with amlodipine [17].…”

Renal function monitoring in heart failure – what is the optimal frequency? A narrative review

“…However, in practice, amlodipine seems to have renoprotective effects in CKD patients, especially when paired with ARBs , probably due to a reduction in renal artery smooth muscle contraction leading to a higher renal flow, even while systemic blood pressure is reduced . Indeed, even a single dose of amlodipine can lead to a demonstrable increase in eGFR in CKD patients .…”