How much can anti-hypertensives affect GFR?

[regcat]

How much can medication affect a GFR? 62 yr old female, resistant hypertension since aged 18. Take ARBs, epleronone, bisoprolol, furosemide, amlodipine, amiloride. BP fantastically well controlled now for past 16 years. It was under medicated for years by my GP who said it was only white coat hypertension (which it wasnt). So I took anti-hypertensives for years but not enough of them/wrong ones. Also have paroxysmal AF - take flecainide and apixaban. GFR 33. Cardio says meds are reducing the GFR - but can't tell me any idea of how much at all. I am terrified that I am so close to ESRD 4. Can anyone help me please - I am close to tears all the time.

[Hidden]

Hi and welcome to the community.

My best advice for you is to go to the website drugs.com and look at their MY MED LIST feature. You can enter all of your medications and when you are finished you'll get a list of all interactions with each other med, food interactions, and also find out which of the meds are possibly harmful to your kidneys. Keep a list of each interaction and when you speak to your nephrologist and cardiologist ask about them and if changes are needed they can prescribe less harmful ones then. Once you set up a free account you can check out new meds when any physician orders a new medication right in the exam room and before you spend money on a new script check for interactions and ask to try something different.

While Type 2 Diabetes was the cause of my CKD, I also have hypertension and take three meds to keep it under control. My twice a day blood pressure readings have averaged 124/72. I was diagnosed with CKD almost 4 years ago with a GFR of 32. Since then I've had an average GFR of 52. You can slow the progression and raise your GFR if you are able to control the underlying conditions.

Best of luck.

[regcat in reply to Hidden]

Thanks for the advice - I should add that the cardio said that "we don't need to do anything" about the GFR of 33 as he ran through the blood results. He just said that and then moved on to tell me about the other results, all of which were ok. He seemed very untroubled about it indeed.

[Hidden in reply to regcat]

The reason he seemed untroubled is that he wasn't speaking about his health. Ask him what he would do if your numbers were his. I'd bet he would be a lot more aggressive in his treatment. You can always see another cardiologist and get a second opinion.

One thing that I've learned since my diagnosis is that my health care is up to me. The medical professionals on my Care Team all know that I expect their best medical advice and then when I decide on which treatment they support that decision.

[regcat in reply to Hidden]

I think you are right - this is a new cardio for me. My previous one retired and this one has only seen me once, a year ago. This time it was a follow up consultation. I had an attack of PAF and his instructions had been to double up Flecainide until it went away. I did that for 5 weeks. He asked for a 48 hour rhythm monitor, that showed a "serious ECG abnormality". I was told to go to A&E immediately. They did the bloods and ECG and sent me home same day saying the bloods were "fine". He rang me and told me that Bisoprolol had caused the problem and to reduce it. I have done that although I am sure that it was Flecainide that did it - I've taken Biso for over 25 years, never had any concerns about it and nor has any doctor. The rhythm is now ok again and I am back on the lower dose of Flecainide. I think maybe he is concerned that he had known I was taking more than normal dose of it and that he had okayed it. During this conversation he went through the blood results....and you know the rest. Goes without saying that I am beside myself with worry. Thanks for your advice - and it was reassuring to hear that your GFR has pulled up so well - all the best!

[Hidden in reply to regcat]

If you would like to look for others in your area, you can go to healthgrades.com and enter the specialty and city and you'll get a list of cardiologists and reviews written by patients as well as what insurance they accept. Again, my best and let us know how this turns out.

[regcat in reply to Hidden]

I'm in the UK so things are a bit different over here - the USA seem much more proactive about CVD, CKD etc. I wish I could get more answers - I emailed the cardio but he has just ignored it - I wanted to know why he had said "we don't need to do anything about that" when a GFR of 33 is clearly not right and heading in a terrible direction. I'm fit and healthy, never been in hospital in my life, been taking anti-hypertensive meds all my adult life and yet here I am. I've never been so frightened in my life - I've tried reading everything I can find online and although I can see that meds do cause GFR to go up and down, I can't find definitive evidence that it can cause GFR to go down so badly - the doctor says oh yes it does that - but I can't find anything much to really confirm that to any great extent. Thanks for your help - even just hearing from someone helps to be honest!

[Hidden in reply to regcat]

In the USA we have a Patient's Bill of Rights and I know you have something similar in the UK. Is there no provision that requires a physician to be open with their patient?

Even though you are in the UK the link and information I provided for drugs.com will still work for you and allow for your checking on medication interactions.

Even in the USA things are slow to change, but recent changes have me hopeful that physicians will start informing their patients sooner that they are in the early stages of CKD and allow them more time to make the lifestyle changes needed to slow the progression and for many an opportunity to perhaps avoid dialysis altogether.

Best of luck.