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Index Copernicus Value: 79.54
ISSN (e)-2347-176x ISSN (p) 2455-0450
DOI: https://dx.doi.org/10.18535/jmscr/v7i2.56

Role of Efonidipine in CKD Patients: A Study In North Bihar

Authors
Dr U. C. Jha , Dr Ashish Narayan2
1
1
MBBS, DTM &H, MD (Medicine), PhD (Medicine), Associate Professor, Department of Medicine, Darbhnaga
Medical College
2
MBBS, PGT 2nd year, MD (Medicine), Darbhanga Medical College

Abstract
The role of efonidipine, a calcium channel blocker in reducing the progression of chronic renal disease is well
established by various studies. It also imparts beneficial effects in cardiovascular disease by reducing synthesis and
secretion of aldosterone, it prevents hypertrophy and remodelling of cardiac myocytes. There is decrease in 24 hour
urinary protein as efonidipine reduces glomerular capillary pressure. And overall there is improvement in GFR too.
The aim of the study is to find the role of efonidipine in CKD patients.
Methods: CKD patients (age >25 years, both gender) attending outdoor clinic and indoor CKD patients of Medicine
department Darbhanga Medical College were selected by simple random method and advised efonidipine 40mg once
daily. The statistical significance of improvement in proteinuria and GFR was measured.
Result: There was improvement in proteinuria in 52% patients taking efonidipine 40mg once daily. The GFR was
increased in 54% patients taking drug.
Out of 50 patients 29 were male and 21 were females. There was substantial decrease in 24 hour urinary protein in 26
patients out of 50 at the end of 6 months period. GFR also improved in 27 patients out of 50 at the end of study period.
Conclusion: Our 24 weeks study period in CKD patients taking efonidipine a novel dihydropyridine calcium antagonist
showed its beneficial effects. The outcome was measured by 24 hour urinary protein excretion and GFR. The beneficial
effect on proteinuria was particularly apparent in patients with proteinuria 1 g/day. These effects of efonidipine would
appear to make the drug more advantageous than other CCBs in terms of slowing the progression of renal dysfunction
and preventing cardiovascular tissue and organ injuries in patients with hypertension and chronic kidney disease.

Introduction enhances sodium excretion from the kidneys by

Efonidipine, is a new generation dihydropyridine suppressing aldosterone synthesis and secretion
(DHP) calcium channel blocker. It blocks both L from the adrenal glands. Aldosterone induced
and T type calcium channel. Calcium channel renal parenchymal fibrosis is also suppressed by
blockers are mainly used in hypertension, angina Efonidipine. Efonidipine increases glomerular
pectoris, cardiac arrhythmias, and hypertrophic filtration rate without increasing intra-glomerular
cardiomyopathy. Efonidipine mainly have shown pressure and filtration fraction. This prevents
to have many beneficial effects on renal outcome hypertension induced renal damage. There are
in CKD patients. Renin angiotensin system have a several studies which showed that efonidipine
major role in hypertension and renal function. reduces proteinuria also.
Efonidipine suppresses renin secretion from the Hypertension is a well known risk factor for
juxta glomerular apparatus in the kidneys and kidney damage and that kidney damage can

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increase blood pressure, thereby leading to a on CKD patients. The patients were followed up
vicious cycle. Having a good blood pressure and assessed at regular intervals and at the end of
control in hypertensive patients can aid to prevent study period for outcomes. Proteinuria, and GFR
long term renal damage. Calcium channel was calculated to evaluate the effects of
blockers are widely used in hypertension. The efonidipine. GFR was calculated by using the
main stratergy is to reduce Glomerular pressure so Cockcroft and Gault formula for both men and
that proteinuria can be minimized. women whereas 24 hour urinary protein was
There are many studies in the past providing estimated for proteinuria.
ample data to confirm the beneficial effects of A sample size of 50 patients was taken. Paired
efonodipine in renal failure. The main aim of the student T test was used to determine the statistical
study is to evaluate the effects of efonidipine in significance. A p value of <0.05 was considered
CKD patients. statistical significant.
No ethical committee issues were raised during
Methods the study.
The type of study was prospective showing the
effects of efnodipine in CKD patients. The study Result
was conducted over a period of six months (1st A total of 50 patients were selected randomly who
March to 31st August 2018) on patients attending fulfilled the inclusion criteria for the study. All
outdoor and indoor clinic of darbhanga medical patients were selected from outdoor n indoor
college and hospital (a government medical admissions in Darbhanga Medical College. 32
college of north Bihar). patients had diabetes and hypertension both
The study group included all CKD patients above whereas 18 patients had only diabetes as a
20 years old of both genders receiving comorbidity.
efonidipine. Seriously ill patients and patients Out of 50 patients 29 were male and 21 were
having co morbid conditions such as females. There was substantial decrease in 24 hour
cardiovascular disease, or any other disease except urinary protein in 26 patients out of 50 at the end
hypertension and diabetes was excluded from of 6 months period. GFR also improved in 27
study. patients out of 50 at the end of study period.
The primary objective of study was to find the
effects of efonidipine either beneficial or harmful

There was improvement in proteinuria in 52% end of the study. The p value came to be .000
patients taking efonidipine 40mg once daily at the which was significant.

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The GFR was calculated prior to the starting of CCB, dilates both the afferent and efferent
the study and at the end of the study. It was found arterioles in the isolated perfused kidney, while
that patients on efonidiopine 40mg daily the L-type CCB preferentially dilates the afferent
improved. The GFR was increased in 54% arterioles. The elevated glomerular hydraulic
patients taking drug. Statistically p value came to pressure promotes ultrafiltration of plasma
be significant. proteins, resulting in proteinuria.
It has been found in many large scale studies that
Discussion the amount of urinary protein excretion was
Diabetes and hypertension are leading causes of predictive for the rate of deterioration of renal
chronic renal failure worldwide. As we know function in patients with diabetic and non diabetic
these patients are also at risk of cardiovascular renal diseases. Proteinuria itself is detrimental to
complications. To prevent such complications the kidney because ultrafiltration of proteins
certain drugs which selectively improve the across the glomerular basement membrane brings
progression and improve the prognosis should be about mesangial and tubular protein overload,
used. which provokes inflammation and ultimately
To protect the kidneys from diabetic and other results in glomerulosclerosis and tubulo-
renal diseases, it is important to prevent the interstitial fibrosis. Proteinuria is also know to be
increase in glomerular capillary pressure. The a risk factor for cardiovascular disease.
drugs acting on rennin angiotensin system, such as Efonidipine, a dihydropirydine calcium channel
ACE inhibitors and ARBs, are known to improve blocker, has been shown to dilate the efferent
glomerular hypertension by reducing the glomerular arterioles as effectively as the afferent
constrictive effect of angiotensin II on the efferent arterioles. It increases glomerular filtration rate
arterioles. With regard to the Ca channels in the without increasing intra-glomerular pressure and
glomerular arterioles, the afferent arterioles filtration fraction. This prevents hypertension
express the L- and T-type Ca channels, while the induced renal damage. It also prevents Rho-
efferent arterioles express only the T-type Ca kinase induced renal parenchymal fibrosis and
channel. This distribution of Ca channels may provides long term renal protection.
explain the experimental observation that Efonidipine is unique among clinically available
efonidipine, the L- and T-type CCBs. Its antihypertensive efficacy is superior or
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at par with other CCBs. But, in terms of Masanori FUJII1), Takashi
pleiotropic effects leading to enhanced cerebral, YAMAMOTO1), and Minoru HORIE1)
cardiac and renal protection, Efonidipine scores Comparison of the Effects of Efonidipine
over the other CCBs. and Amlodipine on Aldosterone in Patients
This study showed the effectiveness of efonidipine with Hypertension.
in providing renal protection in patients of chronic 5. Schulman NB, Ford CE, Hall WD,
renal failure. Blaufox MD, Simon D, Langford HG,
Schneider KA: Prognostic value of serum
Conclusion creatinine and effect of treatment of
A substantial proportion of patients advised hypertension on renal function: Results
efonidipine showed improvements in renal status. from the hypertension detection and
The reno protective benefits of efonidipine was follow-up program. Hypertension
imparted largely due to decrease in proteinuria 1989;13(Suppl 1):I-80–I-93.
and improvement in GFR. 6. Lewis EJ, Hunsicker LG, Bain RP, Rohde
RD, for the Collaborative Study Group:
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