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Calcium-channel blockers and end-stage renal disease: pharmacokinetic and pharmacodynamic considerations

Purpose of reviewTo characterize the pharmacokinetics and pharmacodynamics of the different calcium-channel blockers. Recent findingsCalcium-channel blockers have been in use for some time in the end-stage renal disease population. Their primary use has been as antihypertensive and antianginal therapies. In this regard, they are effective agents. Recently, it has been noted that dialysis-related hypotension occurs less frequently in calcium-channel blocker treated patients. Also, access patency and overall patient survival are improved with calcium-channel blocker therapy. SummaryCalcium-channel blockers are useful agents for the control of hypertension in end-stage renal disease patients and appear to favorably influence survival in this population. Calcium-channel blockers are not dialyzable and their pharmacokinetics do not substantially change with renal failure therefore they do not require dose adjustment based on level of renal function. Too few studies exist to determine if individual calcium-channel blockers differ in their effects. Prospective, randomized, controlled clinical trials are needed in the end-stage renal disease population to better understand the role of calcium-channel blockers in the excess cardiovascular disease burden of this population.