Newer drugs for hypertension offer hope to kidney patients on World Kidney Day, Health News, ET HealthWorld

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Newer drugs for hypertension offer hope to kidney patients on World Kidney DayBy Dr Kamlakar Tripathi, MD, DM (Neph), MNAMS (Neph), DNB (Neph), FRCP(Ed) Former Professor and Head Department of Medicine Institute of Medical Sciences Banaras Hindu University

A day dedicated to the kidney? Yes! Humankind has known about the importance of the kidneys for centuries and World Kidney Day is observed to create awareness about the increasing burden of kidney diseases with 1 in 10 people affected by kidney disease globally.

The kidneys have existed in the form of the excretory unit as excretory vacuole in single-cell animal when none other organ developed million years before and then evolved as pronephros (most basic excretory organ and the first stage of kidney development), mesonephros (the excretory organ in fish and amphibians, mid-development) and metanephros (most developed stage, found in reptiles, birds, and mammals) in non-vertebrate to vertebrate animals. These excretory units repeat the same evolutionary stage in foetus in the mother’s womb before a full-grown kidney and apart from detoxification, excretion they also regulate blood pressure and are important for life as they balance the body’s internal environment by removing toxins from the blood and filtering out waste products through urine. They regulate the water level in the body by removing excess water and help retain water when the body needs more. They produce important hormones that regulate blood pressure and the production of red blood cells. The kidney also helps in maintaining the levels of minerals like calcium and phosphate in the body. A healthy body depends on healthy kidneys that are functioning properly.

Kidney disease is a fallout due to lifestyle changes e.g. dietary habits, sedentary work, and habits such as smoking and excessive intake of alcohol. These have made us prone to lifestyle diseases like obesity, diabetes, and high blood pressure. High blood pressure or hypertension and diabetes are the most common causes of kidney disease and together account for about half of all patients presenting with kidney failure in India. These conditions harm the kidneys by causing damage to the tiny blood vessels and filtering units known as glomeruli in the kidney over a period of years.

Timely diagnosis, proper management, avoidance of nephrotoxic drugs, adequate treatment of hypertension and diabetes will go a long way in addressing the silent progression of kidney disease. Once kidney disease reaches an advanced stage, patients need to go in for regular Hemodialysis or even a transplant, which may not be affordable by many individuals and at present live related donor is the only option due limited availability of cadaver kidney. It is therefore advisable to go in for regular check-ups for high blood pressure and once diagnosed, take steps to control it by following changes in diet, regular exercise, and the regimen advised by the physician with medicines as prescribed.

The treatment of hypertension includes drugs called anti-hypertensives that lower blood pressure and seek to prevent the complications that arise due to the raised blood pressure. These act through different mechanisms – directly on the heart, on the blood vessels or by reducing the fluid in the body.
These include:

Calcium channel blockers

ACE (angiotensin-converting enzyme) inhibitors

ARBs (angiotensin receptor blockers), and Diuretics act on kidneys to increase the excretion of sodium and water to decrease the volume of blood and reduce blood pressure.

Calcium channel blockers are among the first-line drugs in the management of hypertension. They work by decreasing the force of contraction and dilating the arteries which reduce the work the heart has to do to pump blood in the body. While the older generation drugs such as amlodipine has few with side-effects like tachycardia and leg swelling in some individuals. The newer generation of calcium channel blockers like cilnidipine causes less tachycardia, less oedema, and better control of proteinuria (protein in the urine). This newer generation of drugs also causes less damage to the filtering units of the kidney (glomeruli) and gives doctors and hypertensive patients with chronic kidney disease a better and safer choice of medicine for the control of high blood pressure. Cilnidipine’s effect on increasing insulin sensitivity also makes it a good choice for reducing blood pressure while preserving kidney function in people with diabetes.

This year, the theme for World Kidney Day is ‘Living Well with Kidney Disease’, and with modifications of lifestyle and proper medications, hypertension can be controlled well and progression of kidney disease can be halted at an early stage. This will also prevent its progression to a stage where dialysis or transplant may be required.





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