Lisinopril creatinine
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Lisinopril and Creatinine: Impacts and Considerations
Introduction to Lisinopril and Creatinine
Lisinopril is a widely used angiotensin-converting enzyme (ACE) inhibitor, primarily prescribed for hypertension and heart failure. Creatinine, a waste product from muscle metabolism, is a key indicator of kidney function. Understanding the relationship between lisinopril and creatinine levels is crucial for managing patients with renal concerns.
Lisinopril Pharmacokinetics in Renal Failure
Research indicates that lisinopril pharmacokinetics are significantly influenced by renal function. In patients with chronic renal failure, there is a strong correlation between creatinine clearance and both the total area under the curve (AUC) and plateau lisinopril concentration1. This suggests that as renal function declines, lisinopril accumulates in the body, necessitating careful monitoring and dosage adjustments.
Effects on Urinary Albumin and Renal Function
Lisinopril has been shown to reduce urinary albumin excretion (UAE) in hypertensive patients with microalbuminuria, independent of its blood pressure-lowering effects8. This reduction in UAE is beneficial for patients with diabetic nephropathy, as it indicates improved kidney function. Additionally, in a study involving hypertensive diabetic patients, lisinopril normalized elevated serum creatinine levels in approximately 50% of patients, further supporting its renoprotective properties9.
Combination Therapies and Renal Outcomes
Combining lisinopril with other medications can have varying effects on renal function. For instance, a combination of lisinopril and verapamil significantly improved glycemic control and reduced urinary albumin creatinine ratio (UACR) in patients with diabetic nephropathy, without adverse reactions2. However, combining lisinopril with angiotensin-receptor blockers (ARBs) like losartan increased the risk of hyperkalemia and acute kidney injury, highlighting the need for cautious use of combination therapies4.
Impact on Oxidative Stress and Renal Injury
Lisinopril also demonstrates protective effects against oxidative stress-induced renal injury. In hypertensive rat models, lisinopril treatment reduced markers of oxidative stress and improved renal function parameters, such as serum creatinine and microalbumin levels3. This suggests that lisinopril can mitigate renal damage caused by hypertension and oxidative stress.
Safety and Tolerability
While lisinopril is generally well-tolerated, it can cause significant increases in serum creatinine in a small percentage of patients. A study found that 0.2% of patients experienced a rise in creatinine from ≤1.2 mg/dl to >2.5 mg/dl, often due to factors like congestive heart failure or dehydration5. Despite this, the risk of progressing to end-stage renal disease (ESRD) is low, and lisinopril remains a safe option for most patients.
Conclusion
Lisinopril is an effective ACE inhibitor with significant benefits for renal function, particularly in patients with hypertension and diabetic nephropathy. Its impact on creatinine levels necessitates careful monitoring, especially in patients with pre-existing renal impairment. Combination therapies involving lisinopril should be approached with caution to avoid adverse renal outcomes. Overall, lisinopril's renoprotective effects and safety profile make it a valuable treatment option in managing renal and cardiovascular conditions.
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Most relevant research papers on this topic
Lisinopril pharmacokinetics in chronic renal failure.
Lisinopril effectively inhibits angiotensin-converting enzyme activity in chronic renal failure patients, without altering creatinine clearance or causing adverse clinical effects.
Non-RCTEffect of Lisinopril and Verapamil on Angiopoietin 2 and Endostatin in Hypertensive Diabetic Patients with Nephropathy: A Randomized Trial
Lisinopril and verapamil combination effectively improves glycemic control and kidney function in type 2 diabetes mellitus patients with early stage nephropathy by diminishing angiopoietin 2 and endostatin.
RCTLisinopril attenuates renal oxidative injury in l-NAME-induced hypertensive rats
Lisinopril treatment can reduce biochemical alterations in l-NAME-induced hypertensive renal damage caused by oxidative stress.
RCT
Animal StudyCombined angiotensin inhibition for the treatment of diabetic nephropathy.
Combination therapy with an ACE inhibitor and an ARB is associated with an increased risk of adverse events in patients with diabetic nephropathy.
RCT
Large Human Trial
Highly CitedA study of the prevalence of significant increases in serum creatinine following angiotension-converting enzyme inhibitor administration
End-stage renal disease is an unlikely outcome among patients prescribed lisinopril, and is likely associated with other events.
Observational Study
Rigorous JournalValsartan in combination with lisinopril versus the respective high dose monotherapies in hypertensive patients with microalbuminuria: the VALERIA trial
Valsartan and lisinopril combination significantly reduced urine albumin creatinine ratio and more than doubled the rate of patients with normalized urine albumin creatinine ratio compared to lisinopril alone.
RCTHydrochlorothiazide increases plasma or tissue angiotensin-converting enzyme-inhibitor drug levels in rats with myocardial infarction: differential effects on lisinopril and zofenopril.
Hydrochlorothiazide increases steady-state angiotensin-converting enzyme-inhibitor drug levels in rats with myocardial infarction, potentially affecting renal clearance, with lisinopril increasing in plasma and zofenopril accumulating in tissue.
RCTAnimal StudyEffects of lisinopril and nitrendipine on urinary albumin excretion and renal function in patients with mild to moderate essential hypertension.
Lisinopril reduces urinary albumin excretion in essential hypertensive patients with microalbuminuria, while nitrendipine does not, independently of its effective antihypertensive properties.
RCTInfluence of the ACE inhibitor lisinopril on blood pressure, metabolism, and renal function parameter in hypertensive type II diabetic patients: a postmarketing surveillance study.
Lisinopril is a well-tolerated, effective drug for treating hypertension in type II diabetic patients, improving blood pressure, metabolism, and renal function.
Observational StudyLong-acting angiotensin-converting enzyme inhibition: once-daily lisinopril versus twice-daily captopril in mild-to-moderate heart failure.
Both once-daily lisinopril and twice-daily captopril significantly increase exercise duration in patients with mild-to-moderate heart failure, without significantly impacting ventricular ectopic activity.
RCT