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Saudi Journal of Kidney Diseases and Transplantation
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LETTER TO EDITOR Table of Contents   
Year : 2003  |  Volume : 14  |  Issue : 2  |  Page : 202-204
Telmisartan in Hemodialysis


Calle Euskalduna, 10.-1º.A, 48008, Bilbao, Vizcaya, The Basque Country, Spain

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How to cite this article:
Ocharan-Corcuera J, Montenegro J, Sracho R, Martinez I. Telmisartan in Hemodialysis. Saudi J Kidney Dis Transpl 2003;14:202-4

How to cite this URL:
Ocharan-Corcuera J, Montenegro J, Sracho R, Martinez I. Telmisartan in Hemodialysis. Saudi J Kidney Dis Transpl [serial online] 2003 [cited 2019 Oct 18];14:202-4. Available from: http://www.sjkdt.org/text.asp?2003/14/2/202/33031
To the Editor:

The inhibition of angiotensin II (A-II) action remains one of the main objectives in cardiovascular therapy. In this context, over the past decade, angiotensin converting enzyme inhibitors (ACEIs) have afforded the best results in the treatment of cardiovascular disorders and their complications. A new family of A-II receptor blockers has recently been developed, of which losartan was the first to be introduced. This drug selectively antagonizes binding of the peptide to its specific receptors. Unlike the nonspecific antagonist saralasin, these agents are active via the oral route and are non­peptidic in nature, thus exhibiting no agonistic properties.

Telmisartan is a potent new non-peptidic drug that produces selective and non­displaceable inhibition of the AT-1 receptors of angiotensin II, without affecting other receptor systems implicated in cardio­vascular regulation. This drug was specifically developed for the treatment of primary arterial hypertension.

Angiotensin II via the AT-1 receptors not only regulates kidney function but also constitutes a determining factor in renal damage and glomerulosclerosis. Studies in transgenic hypertensive rats have shown that prolonged telmisartan antihypertensive treatment (0.1 µg/kg/day) markedly reduces microalbuminuria and the number of sclerotic glomeruli. These effects were accentuated upon increasing the dose of telmisartan to 0.3 µg/kg/day. These findings were in turn accompanied by important reductions in tubular atrophy and fibrinoid occlusions of the renal arteries. [1]

Telmisartan has been successfully used to control blood pressure in patients with mild or moderate kidney damage. In a 12-week comparative double blind study (10-20 mg enalapril versus 40-80 mg telmisartan) of 71 patients with moderate chronic kidney failure, [2] the recorded creatinine clearance values showed that telmisartan produces no clinically relevant alteration in kidney function, and its safety in such patients was considered to be excellent. [2]

When administering telmisartan to patients with kidney failure, periodic monitoring of the plasma potassium and creatinine concentrations is advised. No experience has been acquired with the use of telmisartan in patients recently subjected to kidney transplantation. [3],[4],[5]

The pharmacokinetic profile of telmisartan (120 mg) has been evaluated in six patients subjected to dialysis. The maximum con­centration (Cmax) and area under the curve (AUC) were lower than in healthy subjects. The mean elimination half-life was practically unmodified (24-25 hours). No significant or relevant differences in the pharmacokinetic characteristics of the drug were observed during dialysis or the periods between dialysis. A decrease of about 1% in the plasma protein binding fraction of the drug has been recorded, due to a change in the serum composition of these patients, the free fraction being two times higher in such individuals. [6]

Telmisartan is not eliminated by hemo­dialysis. However, the distribution and elimination processes are not kidney­dependent; consequently, no differences in terms of effects are to be expected in this group of patients.

The marked lipophilic nature and tissue affinity of the free fraction of telmisartan secures rapid distribution of the drug. [6],[7]

We studied 70 patients on maintenance hemodialysis (HD). The mean age was 62 years, range 24-84; 60% were males. The underlying pathology was glomerulonephritis in 20%, tubulo-interstitial nephritis in 18%, congenital in 18%, vascular in 18% and diabetic in 26%.

Normal blood pressure (defined as a systolic and diastolic arterial pressure of 140 and 90 mmHg, respectively) was recorded in 42% of the series, while 58% received antihy­pertensive treatment. Of the latter patients, 17 received one antihypertensive drug (antiAHT), 12 received two, nine were on three, and two patients received four antiAHT drugs. We added telmisartan (single daily dose) to 10 of these patients all of whom were followed-up over a period of 16 weeks (4 months).

Comparison of the basal systolic (SAP) and diastolic arterial pressures (DAP) (168 and 95 mm Hg, respectively) with the values recorded at one week (158 and 81 mm Hg, respectively) proved to be statistically significant (p<0.05); this trend increased for both parameters in the eighth week (p<0.01) and persisted to the end of the study after 16 weeks [Table - 1].

It is concluded that AHT can be adequately controlled with the new antihypertensive drugs. In this context, telmisartan offers good therapeutic control, and pharmacological tolerance.

 
   References Top

1.Lahera H, Vazquez-Perez S, De Las Heras N, Cediel E, Navarro-Cid J, Cachofeiro V. Angiotensina II e hipertension arterial: Consecuencias del antagonismo de sus receptores. Hipertension 2000;17:22-9.  Back to cited text no. 1    
2.Lahera V, Cachofeiro V, Maeso R, Navarro-Cid J, De las Heras N, Vazquez­Perez S. Caracteristicas farmacologicas de un nuevo antagonista de los receptores AT1 de angiotensina II: telmisartan. Hipertension 1998;15(Suppl 1):S31-8.  Back to cited text no. 2    
3.McInnes GT. Angiotensin II antagonists. Br J Cardiology 1997;4:273-82.  Back to cited text no. 3    
4.McClellan KJ, Markham A. Telmisartan. Drugs 1998;56:1039-46.  Back to cited text no. 4  [PUBMED]  
5.Mackenzie HS. Ziai F, Omer SA, Nadim MK, Taal MW. Angiotensin receptor blockers in chronic renal disease: the promise of a bright clinical future. J Am Soc Nephrol 1999;10:S283-6.  Back to cited text no. 5    
6.Goldberg AI, Dunlay MC, Sweet CS. Safety and tolerability of losartan potassium, an angiotensin II receptor antagonist, compared with hydrochlorothiazide, atenolol, felodipine ER, and angiotensin-converting enzyme inhibitors for the treatment of systemic hypertension. Am J Cardiol 1995;75:793-5.  Back to cited text no. 6  [PUBMED]  [FULLTEXT]
7.Kang PM, Landau AJ, Eberhardt RT, Frishman WH. Angiotensin II receptor antagonists: a new approach to blockade of the renin-angiotensin system. Am Heart J 1994;127:1388-401.  Back to cited text no. 7  [PUBMED]  [FULLTEXT]

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Correspondence Address:
Julen Ocharan-Corcuera
Calle Euskalduna, 10.-1º.A, 48008, Bilbao, Vizcaya, The Basque Country
Spain
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PMID: 18209448

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