On Losartan Potassium - now have raised creatinine levels

Hi MrsO

I assume your sodium level is back to normal now ? Whilst the raised creatinine may respond to stopping the losartan, I doubt the doctors would want to stop unless the rise was exceptionally high. A dose reduction of losartan may be considered but that brings the disadvantage of affecting blood pressure control.

Tarun

Hello Tarun and thank you for replying.....again! Well remembered too with the sodium level which apparently has increased one point to 133 at the most recent blood test. However the Creatinine has increased to 112 - it was previously in the low 90's. I don't know what would be classed as "exceptionally high".

Of course you're right there is no way the Losartan can be reduced as the consultant would like the BP even lower. He explained that I didn't seem to get on with the BP medications that were "kidney neutral" and care had to be taken with the others. I've also just remembered that about 7 years ago the GP started me on Candesartan and rang following the usual first blood test telling me to stop taking it as my creatinine levels were raised. As that is from the same family of drugs as Losartan then I guess this was bound to happen. I so wish, along with many others I suspect, that there was an alternative and natural way to get my BP down but I already have a very healthy diet with no added salt, have a half hour daily walk as fast as I can (although the medication is now slowing me down a bit)am not really overweight at 10st and 5ft 4ins, although do wonder if I could lose a stone whether the BP would reduce as well.

Tarun, do you know if there are any BP medications that will not adversely affect my kidney function, please? I'm really getting worried that the effects from the creatinine will be permanent and lower my eGFR into a worse stage.

I think a creatinine of 112 would not be too concerning - I was thinking closer to 200, or if your GFR was markedly reduced, however it will need to be monitored to make sure it doesn't worsen. I think you fit into the "healthy" category for BMI so not sure how much effect additional weight loss will have on the BP. Have you previously tried beta blockers ? These are a good option in CKD, although they shouldn't be used together with diltiazem as there is a significant risk of low blood pressure and heart rate. Alpha blockers may be another option, which include medicines such as doxazosin. There are other odd drugs which do not fit in a specific class, such as moxonidine, methyldopa and hydralazine but these all bring their own side effects with them. I understand that your nephrologist would want to get the BP down to a pre-specified target but you need to balance that with your quality of life on such medicines. It is often difficult to get BP down despite a number of medicines.

Thank you Tarun - you're a mine of information and I'm very grateful. I believe I will be monitored well as the renal consultant has given me a couple of blood test forms, asking me to have another blood test in 3 weeks followed by a second one four weeks later when I have an appointment to see him again.

I did take the beta blocker, Atenolol, for 3 years some 7 years ago, and was taken off that and switched to Ramipril by another renal consultant following the CKD3 diagnosis who said that Ramipril was better than Atenolol. The CKD diagnosis came following a year undiagnosed, and therefore untreated, with what eventually turned out to be PMR. Unfortunately, because that wasn't diagnosed and treated I also then succumbed to the linked condition GCA within a couple of weeks of starting Ramipril so it was stopped and I remained free of BP medicines for 7 years. During the undiagnosed PMR, for about 7 months I took daily small doses of Ibuprofen just to get me off the bed and into a wheelchair and ambulance for my rheumatology appointments and I strongly suspect the Ibuprofen contributed to the CKD diagnosis.

It was a wonderful local pharmacist (sadly, for us, now retired!) who eventually suspected GCA and PMR and fortunately my second rheumatologist agreed and a few years of steroid treatment was successful and I have been in remission for some 20 months and running a support group for other sufferers.

I will never take Ibuprofen again - I'd had one wonderful functioning kidney for more than 50 years after the other was removed at the age of 12.

I will keep the beta blocker, Atenolol in mind - I believe a lower dose of that worked better than this medium dose of Losartan at keeping my BP down, but then I have to forget I am a few years older!

I do hope I haven't bored you with all the above, but it does probably explain why I'm an awkward patient! Thanks you again, Tarun, you have certainly helped to put my mind at rest.

No problem, happy to help ! If anything a switch from diltiazem to a beta-blocker could be an option if the oedema is persistent. Cannot see the nephrologist wanting to stop the losartan unless your creatinine or potassium shoots up !

Thanks so much again Tarun - I will keep your suggested "switch" option in mind, and the way I felt during my walk yesterday with very achy legs and out of puff means that if I have anything to do with it that switch could become a reality sooner rather than later! Do you have a suggested 'best' option for the beta blocker/reduced kidney function/lowest side effects, please Tarun? I promise to give you a break from my postings after that as I'm sure you are very busy helping others too.

The most commonly prescribed beta-blockers for hypertension tend to be propranolol, atenolol and bisoprolol - carvedilol and metoprolol are others. Caution should be used when starting and up-titrating doses, despite having fewer known effects on the kidney. This issue with using beta blockers is that although they are good anti-hypertensives, they have less evidence to support reducing the risk of strokes, heart attacks etc than ACE inhibitors or angiotensin blockers.

Many thanks again Tarun, for more very helpful information, which I so appreciate - I certainly feel more confident about my predicament now.

Hello,

I take Losartan and have CKD.  My GFR is 24. My creatinine did not increase when I started it and my consultant says that it is good for protecting kidneys. There may be other reasons why your creatinine has risen, for example, if you have had a recent infection.   It has taken  quite a while to get my blood pressure under control, even with Losartan 100 and bendroflumiazide.  My consultant has now prescribed Moxonidine as well which had done the trick.  I am now able to redduce the losartan to 50mg

My wife was diagnosed with CKD about six years ago and was put on an Ace Inhibitor called enalapril as she had hypertension.

Last year, she developed a cough which she could not get rid of, and this was put down to the medication she was taking as it is apparently a common side effect.

she was then put on Losartan 25mg twice daily.

she has been on Losartan nearly 12 months now, but last week she had a routine blood test and her GFR had fallen from 38 to 32 over the twelve month period.

Our GP says he is not overly worried about this at the moment and has scheduled another blood test in about one month.

I have looked on the internet about what Valsartan does to the kidney function etc, and it does say that it can cause an initial fall in GFR and then stabilises and protects the kidney thereafter.

Has anyone else had the same thing happen to them?