Monitoring Kidney Function Through the Use of Candesartan, Telmisartan or Valsartan Antihypertensive Therapy towards Patients CKD
Abstract
Chronic Kidney Disease (CKD) lower kidney function caused by an irreversible reduction in normal nephron function. Globally, CKD contributes to the cause of death. Activation of the Renin-Angiotensin-Aldosterone system is involved in the pathogenesis. ARBs have a cardiorenal protective effect. The purpose of this study was to determine the changes in kidney function with the use of Candesartan, Telmisartan or Valsartan antihypertensive therapies in CKD patients. This research method was a prospective observational cohort study looking at changes in kidney function (BUN and Serum Creatinine) at 1 and 6 months of using Antihypertensive Drugs Valsartan, Telmisartan, and Candesartan and tested by statistical analysis. The number of samples in this study was 72 patients which are 24 patients (Candesartan), 27 patients (Telmisartan), and 21 patients (Valsartan). The results showed that the Candesartan group experienced a decrease in average BUN of 0.13±0.85 mg/dl and serum creatinine of 0.004±0.09 mg/dl with independent t-test p=0.479 (p>0.05), Serum Creatinine p= 0.809 (p>0.05). The Telmisartan group experienced a decrease in average BUN of 4.74±5.16 mg/dl and serum creatinine of 0.33±0.20 mg/dl with Wilcoxon BUN test results p=0.000 (p<0.05), Serum Creatinine p=0.000 (p<0.05). In contrast, in the valsartan group, there was no change. So, it can be said that telmisartan has the highest effectiveness in kidney function (BUN and Serum Creatinine).
References
1. Guirguis-Blake JM, Evans C V., Webber EM, Coppola EL, Perdue LA, Weyrich MS. Screening for Hypertension in Adults: Updated Evidence Report and Systematic Review for the US Preventive Services Task ForceGuirguis-Blake, Janelle M., et al. Screening for Hypertension in Adults: Updated Evidence Report and Systematic Review for the US. JAMA - Journal of American Medical Association. 2021;325(16):1657–1669.
2. Whelton PK, Carey RM, Aronow WS, Ovbiagele B, Casey DE, Smith SC, et al. 2017 Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults A Report of the American College of Cardiology/American Heart Association T. American College of Cardiology Foundation and the American Heart Association. 2017.
3. Jadoul M, Martin P. KDIGO 2018 Prevention, Evaluation and Treatment of Hepatitis C in Chronic Kidney Disease. Kidney International Supplements. 2018;8(3):91-165. [Internet]. Available from: https://kdigo.org/wp-content/uploads/2017/02/KDIGO-2018-Hep-C-GL.pdf
4. Kemenkes RI. Protokol Riset Kesehatan Dasar 2018. Jakarta: Kementerian Kesehatan Republik Indonesia; 2018.
5. Ku E, Lee BJ, Wei J, Weir MR. Hypertension in CKD: Core Curriculum 2019. American Journal of Kidney Diseases. 2019;74(1):120–131.
6. Tuot DS, Grubbs V. Chronic Kidney Disease Care in the US Safety Net. Advances in Chronic Kidney Disease. 2015;22(1):66–73.
7. Wang K, Hu J, Luo T, Wang Y, Yang S, Qing H, et al. Effects of Angiotensin-Converting Enzyme Inhibitors and Angiotensin II Receptor Blockers on All-Cause Mortality and Renal Outcomes in Patients with Diabetes and Albuminuria: a Systematic Review and Meta-Analysis. Kidney and Blood Pressure Research. 2018;43(3):768–779.
8. Chung EYM, Strippoli GFM. Aldosterone Antagonists in Addition to Renin Angiotensin System Antagonists for Preventing the Progression of CKD: Editorial Summary of a Cochrane Review. American Journal of Kidney Diseases. 2021;77(5):810–812.
9. Zhao M, Wang R, Yu Y, Chang M, Ma S, Zhang H, et al. Efficacy and Safety of Angiotensin-Converting Enzyme Inhibitor in Combination with Angiotensin-Receptor Blocker in Chronic Kidney Disease Based on Dose: A Systematic Review and Meta-Analysis. Frontiers in Pharmacology. 2021;12(6).
10. Kim-Mitsuyama S, Soejima H, Yasuda O, Node K, Jinnouchi H, Yamamoto E, et al. Cardiovascular and Renal Protective Role of Angiotensin Blockade in Hypertension with Advanced CKD: A Subgroup Analysis of ATTEMPT-CVD Randomized Trial. Scientific Reports. 2018;8(1):1–12.
11. Benjamin D. Granta, Chelsey A. Smithb, Philip E. Castlec, d, Michael E. Scheurere and RR-K. Trends in Antihypertensive Medication Monotherapy and Combination Use Among US Adults, NHANES 2005–2016. Physiology & Behavior. 2017;176(5):139–148.
12. Judge PK, Haynes R, Herrington WG, Storey BC, Staplin N, Bethel A, et al. Randomized Multicentre Pilot Study of Sacubitril/Valsartan Versus Irbesartan In Patients with Chronic Kidney Disease: United Kingdom Heart And Renal Protection (HARP)-III—Rationale, Trial Design and Baseline Data. Nephrology Dialysis Transplantation. 2016;32(12).
13. Udayani NNW, Riastini NW, Putra IMAS. Perbedaan Efektivitas Penggunaan Obat Amlodipin Tunggal dengan Kombinasi Amlodipin dan Lisinopril pada Pasien Hipertensi Rawat Inap di Rs ‘X’ Tabanan Tahun 2017. Jurnal Ilmiah Medicamento. 2018;4(02):128-133.
14. Corsonello A, Fabbietti P, Formiga F, Moreno-Gonzalez R, Tap L, Mattace-Raso F, et al. Chronic Kidney Disease in the Context of Multimorbidity Patterns: The Role of Physical Performance. BMC Geriatrics. 2020;20(1):1–12.
15. Dewi IK, Aminuddin M, Zulkarnain BS. Analysis of Change in Nt-Probnp After Angiotensin Receptor Blocker (ARB) Therapy in Patient with Heart Failure. Folia Medica Indonesia. 2017;52(4):305.
16.Fandinata SS, Purnamayanti A, Utami PR, Surabaya AF, Farmasi PS, Farmasi F, et al. Efektivitas dan Keamanan Terapi Natrium Diklofenak dan Piroksikam pada Pasien Osteoarthritis di Puskesmas Kota Surabaya. Jurnal Ilmiah Manuntung. 2020;6(2):306–311.
17. Putri NRIAT, Rekawati E, Wati DNK. Relationship of Age, Gender, Hypertension History, and Vulnerability Perception With Physical Exercise Compliance in Elderly. Enfermeria Clinica. 2019;29:541–545.
18. Puspitasari DR, Setyabudi MT, Rohmani A. Hubungan Usia, Graviditas dan Indeks Massa Tubuh dengan Kejadian Hipertensi dalam Kehamilan. Jurnal Kedokteran Muhammadiyah. 2013;2(01)29-33:
19. Fandinata SS, Ernawati I. The Effects of Self Reminder Card to the Successful Treatment of Blood Pressure of Hypertension Patients in Community Health Centers in Surabaya. STRADA: Jurnal Ilmiah Kesehatan. 2020;9(2):831–839.
20. Benjamin Chun-Kit Tong. Associations Between Weight Loss, Kidney Function Decline, and Risk of ESRD in the Chronic Kidney Disease in Children (CKiD) Cohort Study. Physiology & Behavior. 2017;176(5):139–148.
21. Amanda D, Martini S. The Relationship between Demographical Characteristic and Central Obesity with Hypertension. Jurnal Berkala Epidemiologi. 2018;6(1):43.
22. Agrawal A, Kamila S, Reddy S, Lilly J, Mariyala MS. Effect of Telmisartan on Kidney Function in Patients with Chronic Kidney Disease: An Observational Study. Journal of Drug Assessment. 2016;5(1):24–28.
23. Bhava BS S, Subrahmanyam B S, Reddy Ch A, D A, K H, K S, et al. Efficacy of Telmisartan and Enalapril in Patients with Diabetic Nephropathy. Advances in Obesity, Weight Management & Control. 2019;9(2):53–57.
24. Burnier M, Lin S, Ruilope L, Bader G, Durg S, Brunel P. Effect of Angiotensin Receptor Blockers on Blood Pressure and Renal Function in Patients with Concomitant Hypertension and Chronic Kidney Disease: A Systematic Review And Meta-Analysis. Blood Pressure. 2019;29(6):358-354.
25. Khan MY, Pandit S, Abdulkutty J, Navasundi G, Hazra PK, Phadke U, et al. Effectiveness of Telmisartan on Blood Pressure Control in Hypertensive Patients in India: A Real-World Retrospective Study from Electronic Medical Records. Cardiology and Therapy. 2021;10(1):255–569.
2. Whelton PK, Carey RM, Aronow WS, Ovbiagele B, Casey DE, Smith SC, et al. 2017 Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults A Report of the American College of Cardiology/American Heart Association T. American College of Cardiology Foundation and the American Heart Association. 2017.
3. Jadoul M, Martin P. KDIGO 2018 Prevention, Evaluation and Treatment of Hepatitis C in Chronic Kidney Disease. Kidney International Supplements. 2018;8(3):91-165. [Internet]. Available from: https://kdigo.org/wp-content/uploads/2017/02/KDIGO-2018-Hep-C-GL.pdf
4. Kemenkes RI. Protokol Riset Kesehatan Dasar 2018. Jakarta: Kementerian Kesehatan Republik Indonesia; 2018.
5. Ku E, Lee BJ, Wei J, Weir MR. Hypertension in CKD: Core Curriculum 2019. American Journal of Kidney Diseases. 2019;74(1):120–131.
6. Tuot DS, Grubbs V. Chronic Kidney Disease Care in the US Safety Net. Advances in Chronic Kidney Disease. 2015;22(1):66–73.
7. Wang K, Hu J, Luo T, Wang Y, Yang S, Qing H, et al. Effects of Angiotensin-Converting Enzyme Inhibitors and Angiotensin II Receptor Blockers on All-Cause Mortality and Renal Outcomes in Patients with Diabetes and Albuminuria: a Systematic Review and Meta-Analysis. Kidney and Blood Pressure Research. 2018;43(3):768–779.
8. Chung EYM, Strippoli GFM. Aldosterone Antagonists in Addition to Renin Angiotensin System Antagonists for Preventing the Progression of CKD: Editorial Summary of a Cochrane Review. American Journal of Kidney Diseases. 2021;77(5):810–812.
9. Zhao M, Wang R, Yu Y, Chang M, Ma S, Zhang H, et al. Efficacy and Safety of Angiotensin-Converting Enzyme Inhibitor in Combination with Angiotensin-Receptor Blocker in Chronic Kidney Disease Based on Dose: A Systematic Review and Meta-Analysis. Frontiers in Pharmacology. 2021;12(6).
10. Kim-Mitsuyama S, Soejima H, Yasuda O, Node K, Jinnouchi H, Yamamoto E, et al. Cardiovascular and Renal Protective Role of Angiotensin Blockade in Hypertension with Advanced CKD: A Subgroup Analysis of ATTEMPT-CVD Randomized Trial. Scientific Reports. 2018;8(1):1–12.
11. Benjamin D. Granta, Chelsey A. Smithb, Philip E. Castlec, d, Michael E. Scheurere and RR-K. Trends in Antihypertensive Medication Monotherapy and Combination Use Among US Adults, NHANES 2005–2016. Physiology & Behavior. 2017;176(5):139–148.
12. Judge PK, Haynes R, Herrington WG, Storey BC, Staplin N, Bethel A, et al. Randomized Multicentre Pilot Study of Sacubitril/Valsartan Versus Irbesartan In Patients with Chronic Kidney Disease: United Kingdom Heart And Renal Protection (HARP)-III—Rationale, Trial Design and Baseline Data. Nephrology Dialysis Transplantation. 2016;32(12).
13. Udayani NNW, Riastini NW, Putra IMAS. Perbedaan Efektivitas Penggunaan Obat Amlodipin Tunggal dengan Kombinasi Amlodipin dan Lisinopril pada Pasien Hipertensi Rawat Inap di Rs ‘X’ Tabanan Tahun 2017. Jurnal Ilmiah Medicamento. 2018;4(02):128-133.
14. Corsonello A, Fabbietti P, Formiga F, Moreno-Gonzalez R, Tap L, Mattace-Raso F, et al. Chronic Kidney Disease in the Context of Multimorbidity Patterns: The Role of Physical Performance. BMC Geriatrics. 2020;20(1):1–12.
15. Dewi IK, Aminuddin M, Zulkarnain BS. Analysis of Change in Nt-Probnp After Angiotensin Receptor Blocker (ARB) Therapy in Patient with Heart Failure. Folia Medica Indonesia. 2017;52(4):305.
16.Fandinata SS, Purnamayanti A, Utami PR, Surabaya AF, Farmasi PS, Farmasi F, et al. Efektivitas dan Keamanan Terapi Natrium Diklofenak dan Piroksikam pada Pasien Osteoarthritis di Puskesmas Kota Surabaya. Jurnal Ilmiah Manuntung. 2020;6(2):306–311.
17. Putri NRIAT, Rekawati E, Wati DNK. Relationship of Age, Gender, Hypertension History, and Vulnerability Perception With Physical Exercise Compliance in Elderly. Enfermeria Clinica. 2019;29:541–545.
18. Puspitasari DR, Setyabudi MT, Rohmani A. Hubungan Usia, Graviditas dan Indeks Massa Tubuh dengan Kejadian Hipertensi dalam Kehamilan. Jurnal Kedokteran Muhammadiyah. 2013;2(01)29-33:
19. Fandinata SS, Ernawati I. The Effects of Self Reminder Card to the Successful Treatment of Blood Pressure of Hypertension Patients in Community Health Centers in Surabaya. STRADA: Jurnal Ilmiah Kesehatan. 2020;9(2):831–839.
20. Benjamin Chun-Kit Tong. Associations Between Weight Loss, Kidney Function Decline, and Risk of ESRD in the Chronic Kidney Disease in Children (CKiD) Cohort Study. Physiology & Behavior. 2017;176(5):139–148.
21. Amanda D, Martini S. The Relationship between Demographical Characteristic and Central Obesity with Hypertension. Jurnal Berkala Epidemiologi. 2018;6(1):43.
22. Agrawal A, Kamila S, Reddy S, Lilly J, Mariyala MS. Effect of Telmisartan on Kidney Function in Patients with Chronic Kidney Disease: An Observational Study. Journal of Drug Assessment. 2016;5(1):24–28.
23. Bhava BS S, Subrahmanyam B S, Reddy Ch A, D A, K H, K S, et al. Efficacy of Telmisartan and Enalapril in Patients with Diabetic Nephropathy. Advances in Obesity, Weight Management & Control. 2019;9(2):53–57.
24. Burnier M, Lin S, Ruilope L, Bader G, Durg S, Brunel P. Effect of Angiotensin Receptor Blockers on Blood Pressure and Renal Function in Patients with Concomitant Hypertension and Chronic Kidney Disease: A Systematic Review And Meta-Analysis. Blood Pressure. 2019;29(6):358-354.
25. Khan MY, Pandit S, Abdulkutty J, Navasundi G, Hazra PK, Phadke U, et al. Effectiveness of Telmisartan on Blood Pressure Control in Hypertensive Patients in India: A Real-World Retrospective Study from Electronic Medical Records. Cardiology and Therapy. 2021;10(1):255–569.
Authors
Fandinata, S. S., Darmawan, R. ., Utami, P. R. ., & Ulfa, N. M. . (2022). Monitoring Kidney Function Through the Use of Candesartan, Telmisartan or Valsartan Antihypertensive Therapy towards Patients CKD. Media Kesehatan Masyarakat Indonesia, 18(1), 1-9. https://doi.org/10.30597/mkmi.v18i1.17780
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