Pharmacokinetics, pharmacodynamics, and safety of lisinopril in pediatric kidney transplant patients: Implications for starting dose selection

Academic Article

Abstract

  • Hypertension in pediatric kidney transplant recipients contributes to long-term graft loss, yet treatment options - including angiotensin-converting enzyme inhibitors - are poorly characterized in this vulnerable population. We conducted a multicenter, open-label pharmacokinetic (PK) study of daily oral lisinopril in 22 children (ages 7-17 years) with stable kidney transplant function. Standard noncompartmental PK analyses were performed at steady state. Effects on blood pressure were examined in lisinopril-naïve patients (n = 13). Oral clearance declined in proportion to underlying kidney function; however, in patients with low estimated glomerular filtration rate (30-59 ml/min per 1.73m 2), exposure (standardized to 0.1 mg/kg/day dose) was within the range reported previously in children without a kidney transplant. In lisinopril-naïve patients, 85% and 77% had a ≥ 6 mmHg reduction in systolic and diastolic blood pressure, respectively. Lisinopril was well tolerated. Our study provides initial insight on lisinopril use in children with a kidney transplant, including starting dose considerations.
  • Authors

    Digital Object Identifier (doi)

    Pubmed Id

  • 12115173
  • Author List

  • Trachtman H; Frymoyer A; Lewandowski A; Greenbaum LA; Feig DI; Gipson DS; Warady BA; Goebel JW; Schwartz GJ; Lewis K
  • Start Page

  • 25
  • End Page

  • 33
  • Volume

  • 98
  • Issue

  • 1