Lercanidipine in patients with chronic renal failure:: The ZAFRA study

Objective: The objective was primary to evaluate the safe use of a new calcium channel blocker, lercanidipine, in patients with chronic renal failure (CRF). The secondary objective was to study the protective effect of calcium channel blocker on renal function in CRF patients previously treated with ACE inhibitors or angiotensin receptor blockers. Design and Methods: The study recruited 203 CRF patients (creatinine > 1.4 mg/dL for males, creatinine > 1.2 mg/dL for females, or creatinine clearance < 70 mL/min). All patients were receiving ACE inhibitors (63.4%) or angiotensin II antagonist (36.6%) therapy, but they had higher blood pressure than recommended for CRF (130/85 mmHg). No patients were under diuretic treatment. Patients were clinically evaluated 1, 3, and 6 months after starting treatment with lercanidipine. Samples for urine and blood examination were taken during the examination. When needed, a third drug was added to the treatment, excluding diuretics. Creatinine clearance was measured using 24 h urine collection. Results: 175 patients rendered valuable for the study (age 63.9 +/- 11.9 years, 52.9% males and 47.1% females). Blood pressure (BP) significantly decreased from 162 +/- 17/93 +/- 8.3 mmHg to 132 +/- 12/78 +/- 6 mmHg. 89.2% of patients showed a significant BP reduction, and 58.1% achieved optimal BP control (< 130/85 mmHg). Seven patients (3.4%) showed untoward effects. Not one case of edema was detected, and the prevalence of adverse effects related to vasodilatation was extremely low (three patients, 1.48%). Plasmatic creatinine did not change (1.9 +/- 0.5 baseline versus 1.9 +/- 0.6 mg/dL), but creatinine clearance increased at the end visit (41.8 +/- 16.0 baseline versus 45.8 +/- 18.0 mL/min, p = 0.019). Plasmatic cholesterol also decreased from 221 +/- 46 to 211 +/- 35 mg/dL (p = 0.001). Conclusions: Lercanidipine showed a high antihypertensive effect in CRF patients. It has a good tolerability profile and showed an interesting effect on plasmatic lipids. An improvement in renal function, measured through creatine clearance, was detected.