Advertisement

The Use of Cardiovascular Drugs in Chronic Renal Failure

  • Suzanne K. Swan
  • William M. Bennett
Part of the Topics in Renal Medicine book series (TIRM, volume 10)

Abstract

The elimination of many therapeutic agents and their metabolites from the body requires adequate renal function. In addition, the kidney is more than a simple excretory conduit, since renal insufficiency impacts on most pharmacologic processes involved in drug metabolism. Patients with cardiovascular disease and renal dysfunction represent one of the most common and certainly most challenging clinical subpopulations in medicine. The clinician managing these particular patients constantly walks a therapeutic tightrope in trying to achieve maximal efficacy while avoiding toxicity. In this chapter, basic pharmacologic principles will be examined under normal and uremic conditions. Dosage recommendations for cardiovascular drugs, including antiarrhythmics, calcium antagonists, diuretics, nitrates, and inotropic agents, in patients with chronic renal failure will be presented in tabular form.

Keywords

Renal Failure Renal Insufficiency Chronic Renal Failure Angiotensin Convert Enzyme Inhibitor Hepatic Metabolism 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Cockcroft DW, Gault MH. 1976. Prediction of creatinine clearance from serum creatinine. Nephron 16:32.CrossRefGoogle Scholar
  2. 2.
    Harrison DC. 1985. Antiarrhythmic drug classification. New science and practical applications. Am J Cardiol 56:185–187.PubMedCrossRefGoogle Scholar
  3. 3.
    Kessler KM, Lowenthal DT, Warner H, Gibson T, Briggs W, Reidenberg MM. 1974. Unimpaired quinidine elimination in patients with poor renal function or congestive heart failure. N Engl J Med 290:706–709.PubMedCrossRefGoogle Scholar
  4. 4.
    Drayer DE, Lowenthal DT, Restive KM, Schwartz A, Cook CE, Reidenberg MM. 1978. Steady state serum levels of quinidine and active metabolites in cardiac patients with varying degrees of renal function. Clin Pharmacol Ther 24:31–39.PubMedGoogle Scholar
  5. 5.
    Doering W, Ficht B, Hermann R, Besenfelder E. 1982. Quinidine-digoxin interation: evidence of involvement of an extrarenal mechanism. Eur J Clin Pharmacol 21:281–285.PubMedCrossRefGoogle Scholar
  6. 6.
    Ochs HR, Greenblatt DJ, Woo E. 1980. Clinical pharmacokinetics of quinidine. Clin Pharmacokinet 5:150.PubMedCrossRefGoogle Scholar
  7. 7.
    Shen DD, Cunningham JL, Shudo I. 1980. Disposition kinetics of disopyramide in patients with renal insufficiency. Biopharmaceut Drug Disposition 1:133.CrossRefGoogle Scholar
  8. 8.
    Strong JM, Mayfield DE, Atkinson AJ, Brris JJ, Raymond W. 1975. Pharmacological activity, metabolism, and pharmacokinetics of glycinexylide. Clin Pharmacol Ther 17: 184–194.PubMedGoogle Scholar
  9. 9.
    Weigers U, Hanroth P, Kick KH, Potlase A, Graffner C, Augustine S, Runge M. 1983. Pharmacokinetics of tocainide in patients with renal dysfunction and during hemodialysis. Eur J Clin Pharmacol 24:503–507.CrossRefGoogle Scholar
  10. 10.
    Wang T, Wuellner D, Woosley R, Stone W. 1985. Pharmacokinetics and nondialyzability of mexiletine in renal failure. Clin Pharmacol Ther 37:649–653.PubMedCrossRefGoogle Scholar
  11. 11.
    El Allaf D, Crochelet HL, Delapierre D, Carlier J, Dresse A. 1982. Pharmacokinetics of mexiletine in renal insufficiency. Br J Clin Pharmacol 14:431–435.PubMedCrossRefGoogle Scholar
  12. 12.
    Evers J, Messer W, Aboudan F, Finke K. 1989. Mexiletine in end-stage renal insufficiency and removal by dialysis. Klin Wochenschr 67:995–998.PubMedCrossRefGoogle Scholar
  13. 13.
    Nora MO, Krishnaswamy C, Hammill SC, Reeder GS. 1989. Prolongation of ventricular depolarization, EKG manifestion of mexiletine toxicity. Chest 95:925–928.PubMedCrossRefGoogle Scholar
  14. 14.
    Bigger JT. 1984. The interaction of mexiletine with other cardiovascular drugs. Am Heart J 10:1079–1085.CrossRefGoogle Scholar
  15. 15.
    Mikus G, Gross AS, Beckmann J, Hertrampf R, Gundert-Remy V, Eichelbaum M. 1989. The influence of the sparteine/debrisoquin phenotype on the disposition of flecainide. Clin Pharmacol Ther 45:562–567.PubMedCrossRefGoogle Scholar
  16. 16.
    Borgeat A, Biollaz J, Freymond B, Bayer-Berger M, Chiolero R. 1988. Hemofiltration clearance of flecainide in a patient with acute renal failure. Intensive Care Med 14:236–237.PubMedCrossRefGoogle Scholar
  17. 17.
    Parker RB, McCollam PL, Bauman JL. 1989. Propafenone: a novel type Ic antiarrhythmic agent. DICP Ann Pharmacother 23:196–203.Google Scholar
  18. 18.
    Burgess E, Duff H, Wilkes P. 1989. Propafenone disposition in renal insufficiency and renal failure. J Clin Pharmacokinet 12:305–320.Google Scholar
  19. 19.
    Stone WJ, Walle TJ. 1980. Massive propranolol metabolite retention during maintenance hemodialysis. Clin Pharmacol Ther 28:449–455.PubMedCrossRefGoogle Scholar
  20. 20.
    Riddell JG, Harron DWG, Shanks RG. 1987. Clinical pharmacokinetics of β-adrenoreceptor antagonists. Clin Pharmacokinet 12:305–320.PubMedCrossRefGoogle Scholar
  21. 21.
    Haltenson CE, Opsahl JA, Pence TV, Luke DR, Sirgo MA, Plachetka JR, Abraham PA, Matzke GR. 1986. The disposition and dynamics of labetalol in patients on dialysis. Clin Pharmacol Ther 40:462–468.CrossRefGoogle Scholar
  22. 22.
    Harris L, McKenna WJ, Krikler SJ, Hind CRK, Savage C, Storly GCA, Holt DW. 1983. Renal elimination of amiodarone and its desethyl metabolite. Postgrad Med J 59:440–442.PubMedCrossRefGoogle Scholar
  23. 23.
    Lesko LJ. 1989. Pharmacokinetic drug interactions with amiodarone. Clin Pharmacokinet 17:130–140.PubMedCrossRefGoogle Scholar
  24. 24.
    Adir J, Narang PK, Josselson J, Sadler J. 1979. Pharmacokinetics of bretylium in patients with impaired renal function. N Engl J Med 300:1390–1391.PubMedCrossRefGoogle Scholar
  25. 25.
    Josselson J, Narang P, Adir J, Yacobi A, Sadler JH. 1983. Bretylium kinetics in renal insufficiency. Clin Pharmacol Ther 33:144–150.PubMedCrossRefGoogle Scholar
  26. 26.
    Echizen H, Eichelbaum M. 1986. Clinical pharmacokinetics of verapamil. Clin Pharmacokinet 11:425–449.PubMedCrossRefGoogle Scholar
  27. 27.
    McTavish D, Sorkin E. 1989. Verapamil—an updated review of its pharmacodynamic and pharmacokinetic properties and therapeutic use in hypertension. Drugs 38:19–76.PubMedCrossRefGoogle Scholar
  28. 28.
    Mooy J, Schols M, Van Baak M, Van Hooff M, Maytjems A, et al. 1985. Pharmacokinetics of verapamil in patients with renal failure. Eur J Clin Pharmacol 28:405–410.PubMedCrossRefGoogle Scholar
  29. 29.
    MacPhee GJA, Mclnnes GT, Agnew E, Brodie MJ. 1986. Clinically relevant adverse interactions between verapamil and carbamazepine in epileptic patients. Br J Clin Pharmacol 21:569p–570p.Google Scholar
  30. 30.
    Buckley MM, Grant SM, Goa KL, McTavish D, Sorkin EM. 1990. Diltiazem—a reappraisal of its pharmacologic properties and therapeutic uses. Drugs 39:757–806.PubMedCrossRefGoogle Scholar
  31. 31.
    Bortel L, Böhm R, Mooy J, Schiffers P, Rahn KH. 1989. Pharmacokinetics of nitrendipine in terminal renal failure. Eur J Clin Pharmacol 36:467–471.PubMedCrossRefGoogle Scholar
  32. 32.
    Kühnel HJ, Günther K, Stein G, Hoffmann-Traeger A. 1987. Pharmacokinetics and pharmacodynamics of high dose furosemide in patients with chronic renal failure or nephrotic syndrome. Int J Clin Pharmacol Ther Toxicity 25:616–621.Google Scholar
  33. 33.
    Marcantonio LA, Auld WHR, Murdock WR, Purohit R, Spellern GG, Howes CA. 1983. The pharmcokinetics and pharmacodynamics of the diuretic bumetanide in hepatic and renal disease. Br J Clin Pharmacol 15:245–252.PubMedCrossRefGoogle Scholar
  34. 34.
    Boles U, Schoenwald RD. 1990. Furosemide— a pharmacokinetic/pharmacodynamic review. Clin Pharmacokinet 18:460–471.CrossRefGoogle Scholar
  35. 35.
    Beermann B, Grind M. 1987. Clinical pharmacokinetics of some newer diuretics. Clin Pharmacokinet 13:254–266, 1987.PubMedCrossRefGoogle Scholar
  36. 36.
    Aronson JK. 1983. Clinical pharmacokinetics of cardiac glycosides in patients with renal dysfunction. Clin Pharmacokinet 8:155–178.PubMedCrossRefGoogle Scholar
  37. 37.
    Gault MH, Vasdev SC, Longerich LL. 1984. Endogenous digoxin-like substances and combined hepatic and renal failure. Ann Intern Med 101:567.PubMedGoogle Scholar
  38. 38.
    Majerus TC, Dasta JF, Bauman JL, Danziger LH, Ruffolo PR. 1989. Dobutamine— 10 years later. Pharmacotherapy 9:245–259.PubMedGoogle Scholar
  39. 39.
    Larrson R, Liedholm H, Andersson KE, Keane MA, Henry G. 1986. Pharmacokinetics and effects on blood pressure on a single oral dose of milrinone in healthy subjects and in patients with renal impairment. Eur J Clin Pharmacol 29:549–553.CrossRefGoogle Scholar
  40. 40.
    Rocci ML, Wilson H. 1987. The pharmacokinetics and pharmacodynamics of new inotropic agents. Clin Pharmacokinet 13:91–109.PubMedCrossRefGoogle Scholar
  41. 41.
    Fung H-L. 1987. Pharmacokinetics and pharmacodynamics of organic nitrates. Am J Cardiol 60:4H–9H.PubMedCrossRefGoogle Scholar
  42. 42.
    Belz GG, Kirch W, Kleinbloesem CH. 1988. Angiotensin-converting enzyme inhibitors— Relationship between pharmacodynamics and pharmacokinetics. Clin Pharmacokinet 15: 295–318.PubMedCrossRefGoogle Scholar
  43. 43.
    Kelly JG, Doyle GD, Carmody M, Glover DR, Cooper WD. 1988. Pharmacokinetics of lisinopril, enalapril and enalaprilat in renal failure: effect of hemodialysis. Br J Clin Pharmacol 26:781–786.PubMedCrossRefGoogle Scholar
  44. 44.
    Duckin KL, McKinstry DN, Cohen AI, Migdalof BH. 1988. Pharmacokinetics of captopril in healthy subjects and in patients with cardiovascular diseases. Clin Pharmacokinet 14: 241–259.CrossRefGoogle Scholar
  45. 45.
    Schumkert H, Kindlu J, Gassmann M, Lahn W, Irmisch R, Debusmann Er, Ocon-Pujadas J, Sieberth HG. 1989. Steady state kinetics of ramipril in renal failure. J Cardiovasc Pharmacol 13(Suppl 3):S52–S54.CrossRefGoogle Scholar
  46. 46.
    Onoyama K, Namishi F, Okuda S, Oh Y, Fujishima M, Tateno M, Omal T. 1988. Pharmacokinetics of a new angiotensin I converting enzyme inhibitor (delapril) in patients with deteriorated kidney function and in normal control subjects. Clin Pharmacol Ther 43:242–249.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 1992

Authors and Affiliations

  • Suzanne K. Swan
  • William M. Bennett

There are no affiliations available

Personalised recommendations