COMPARISON OF ANTI-PROTEINURIC EFFECTS OF AMLODIPINE AND CILNIDIPINE AS AN ADD-ON DRUG TO BASELINE MEDICATION IN HYPERTENSIVE CHRONIC KIDNEY DISEASE PATIENTS

JESMI JAMES; DHANYA JAYAKUMAR; GOMATHY SANKARAN

doi:10.22159/ajpcr.2024.v17i4.49756

Authors

JESMI JAMES Department of Pharmacology, Mount Zion Medical College, Adoor, Pathanamthitta, Kerala, India
DHANYA JAYAKUMAR Department of Pharmacology, Government Medical College, Kochi, Kerala, India.
GOMATHY SANKARAN Department of Nephrology, Government Medical College, Alappuzha, Kerala, India

DOI:

https://doi.org/10.22159/ajpcr.2024.v17i4.49756

Keywords:

Hypertension, Chronic kidney disease, Cilnidipine, Amlodipine, Proteinuria.

Abstract

Objectives: The objectives of the study were to compare the anti-proteinuric effects of amlodipine and cilnidipine in individuals with Chronic Kidney Disease (CKD) on baseline medication.

Methods: This was a prospective observational study carried out in the Department of Nephrology at Government T.D. Medical College, Alappuzha spanning a duration of 1 year from January 2016 to December 2016. The study encompassed a total of 90 hypertensive CKD patients-45 were administered amlodipine and the remaining 45 were given cilnidipine in conjunction with their existing baseline medications. The inclusion criteria consisted of hypertensive CKD patients aged between 18 and 80 years possessing a Glomerular Filtration Rate (GFR) between 30 and 60 mL/min and exhibiting blood pressure readings surpassing 140/90 mmHg despite receiving a loop diuretic (Tab. Frusemide 80 mg BD), an α-blocker (Tab. Prazosin 10 mg BD) and a β-blocker (Tab. Metoprolol 50 mg BD) for a minimum duration of one month. The key parameters that were monitored were sitting systolic and diastolic blood pressure readings and proteinuria which was evaluated by determining the Urine Protein Creatinine (UPC) ratio using untimed random urine samples. The GFR was calculated utilizing the Cockcroft-Gault formula.

Results: The number of patients who improved to stage 3A CKD from stage 3B CKD were more with cilnidipine which indicates its reno-protective action. Amlodipine was seen to have no effect on UPC ratio whereas cilnidipine decreased UPC ratio significantly.

Conclusion: Unlike amlodipine, cilnidipine exhibits marked reduction in proteinuria and improved GFR thereby preventing progression of hypertensive CKD patients to end stage renal failure.

Downloads

Download data is not yet available.

References

Levey AS, Coresh J, Balk E, Kausz AT, Levin A, Steffes MW, et al. National kidney foundation practice guidelines for chronic kidney disease: Evaluation, classification and stratification. Ann Intern Med. 2003 Jul 15;139(2):137-47. doi: 10.7326/0003-4819-139-2- 200307150-00013, PMID 12859163

Jha V, Garcia-Garcia G, Iseki K, Li Z, Naicker S, Plattner B, et al. Chronic kidney disease: Global dimension and perspectives. Lancet. 2013 Jul 20;382(9888):260-72. doi: 10.1016/S0140-6736(13)60687-X, PMID 23727169

Agarwal SK, Dash SC, Irshad M, Raju S, Singh R, Pandey RM. Prevalence of chronic renal failure in adults in Delhi, India. Nephrol Dial Transplant. 2005 Aug;20(8):1638-42. doi: 10.1093/ndt/gfh855, PMID 15855202

Go AS, Chertow GM, Fan D, McCulloch CE, Hsu CY. Chronic kidney disease and the risks of death, cardiovascular events, and hospitalization. N Engl J Med. 2004 Sep 23;351(13):1296-305. doi: 10.1056/NEJMoa041031, PMID 15385656

National Kidney Foundation. KDOQI clinical practice guideline for diabetes and CKD: 2012 update. Am J Kidney Dis. 2012;60(5):850-86. doi: 10.1053/j.ajkd.2012.07.005, PMID 23067652

Chronic Kidney Disease: Practice Essentials, Pathophysiologyand Etiology. Available from: https://emedicine.medscape.com/ article/238798-overview [Last accessed on 2022 Jul 01].

Hsu TW, Liu JS, Hung SC, Kuo KL, Chang YK, Chen YC, et al. Renoprotective effect of renin-angiotensin-aldosterone system blockade in patients with predialysis advanced chronic kidney disease, hypertension, and anemia. JAMA Intern Med. 2014;174(3):347-54. doi: 10.1001/jamainternmed.2013.12700, PMID 24343093

Krol GD. Chronic kidney disease staging and progression. In: Yee J, Krol GD, editors. Chronic Kidney Disease (CKD): Clinical Practice Recommendations for Primary Care Physicians and Healthcare Providers-A Collaborative Approach. 6th ed. United States: Henry Ford Health; 2011. p. 9.

James PA, Oparil S, Carter BL, Cushman WC, Dennison-Himmelfarb C, Handler J, et al. 2014 Evidence-based guideline for the management of high blood pressure in adults: Report from the panel members appointed to the eighth joint national committee (JNC 8). JAMA 2014;311:507-20. doi: 10.1001/jama.2013.284427, PMID 24352797

Chandra KS, Ramesh G. The fourth-generation calcium channel blocker: Cilnidipine. Indian Heart J. 2013 Dec;65(6):691-5. doi: 10.1016/j.ihj.2013.11.001, PMID 24407539

Fujita T, Ando K, Nishimura H, Ideura T, Yasuda G, Isshiki M, et al. Antiproteinuric effect of the calcium channel blocker cilnidipine added to renin-angiotensin inhibition in hypertensive patients with chronic renal disease. Kidney Int. 2007;72(12):1543-9. doi: 10.1038/ sj.ki.5002623, PMID 17943080

Rose GW, Ikebukoro H, Ikebukuro H, Kaneko M, Kaneko K, Kanno T, et al. Cilnidipine is as effective as benazepril for control of blood pressure and proteinuria in hypertensive patients with benign nephrosclerosis. Hypertens Res. 2001;24:377-83.

Kojima S, Shida M, Yokoyama H. Comparison between cilnidipine and amlodipine besilate with respect to proteinuria in hypertensive patients with renal diseases. Hypertens Res. 2004;27(6):379-85. doi: 10.1291/ hypres.27.379, PMID 15253102

Tsuchihashi T, Ueno M, Tominaga M, Kajioka T, Onaka U, Eto K, et al. Anti-proteinuric effect of an N-type calcium channel blocker, cilnidipine. Clin Exp Hypertens. 2005 Nov;27(8):583-91. doi: 10.1080/10641960500298558, PMID 16303635

Katayama K, Nomura S, Ishikawa H, Murata T, Koyabu S, Nakano T. Comparison between valsartan and valsartan plus cilnidipine in type II diabetics with normo-and microalbuminuria. Kidney Int. 2006;70(1):151-6. doi: 10.1038/sj.ki.5000349, PMID 16710356

Zhou X, Ono H, Ono Y, Frohlich ED. N-and L-type calcium channel antagonist improves glomerular dynamics, reverses severe nephrosclerosis, and inhibits apoptosis and proliferation in an l-NAME/ SHR model. J Hypertens. 2002;20(5):993-1000. doi: 10.1097/00004872- 200205000-00035, PMID 12011661