A Cross-Over Comparison of Anti-Albuminuric Effects Among 4 Types Calcium Channel Blockers on Chronic Kidney Disease: Pp.33.310

Background and Objectives: At the intervention for hypertension with chronic kidney disease (CKD), albuminuria is one of the pivotal targets as well as strict blood pressure (BP) control for organ protection. Calcium channel blocker (CCB) is one of the most expected agents for CKD. Currently CCBs have been classified by half-life, drug delivery system and channel types. We tested anti-albuminuric effect and humoral factors level of 4 types of CCBs in CKD. Methods: Subjects were 50 hypertensives with CKD (male/female 22/28, age 69.8±10.8yrs, SBP/DBP 164.7±17.1/92.3±12.2 mmHg, s-Cr 0.81±0.37 mg/dl, urinary albumin excretion (UAE) 69.4 (33.5–142.6) mg/gCr). CCBs were administered for 12 weeks in a crossover manner. Tested agents were nifedipine CR, a long biological half-life L type CCB with controlled release system, cilnidipine, an N/L type CCB, efonidipine, a T/L type CCB and amlodipine, a long biological half-life L type CCB with trans-membrane approach. Results: Comparable BP reductions were obtained. UAE at endpoints ware as follow (mg/gCr, *P < 0.05): nifedipine CR 30.8 (17.3–81.1),* cilnidipine 33.9 (18.0–67.7),* efonidipine 51.0 (21.2–129.8), amlodipine 40.6 (18.7–94.7). By all agents, significant augmentations were observed in PRA, angiotensin I and angiotensin II (AngII). AngII at cilnidipine was significantly lower than that at amlodipine. PAC at cilnidipine and efonidipine was significantly lower than that at amlodipine. Nifedipine CR significantly reduced ANP concentration. Conclusions: It is revealed for the first time that, although all tested drugs reduced UAE, only nifedipine CR and cilnidipine could reach statistical difference. Thus, it is suggested that, in respect of albuminuria reduction, the 2 CCBs might be favorable for organ protection in CKD.