Atrasentan

How it works

It selectively blocks the endothelin A receptor, reducing endothelin-1-mediated vasoconstriction, mesangial proliferation and glomerular injury, thereby lowering proteinuria.

Prescribing in practice

• Endothelin receptor antagonists carry a class risk of fluid retention and oedema, which can precipitate or worsen heart failure.
• This class is teratogenic, so pregnancy must be excluded and effective contraception used.
• It is generally used as an adjunct to standard renin-angiotensin system blockade rather than as monotherapy.

Monitoring

Monitor for fluid retention, weight gain and signs of heart failure, along with proteinuria and renal function.

Counselling the patient

• Report rapid weight gain, ankle swelling or breathlessness promptly.
• Effective contraception is essential because of the risk of harm to a pregnancy.
• Continue your other kidney-protective medicines as directed.

Evidence & guidelines

Endothelin receptor antagonists have shown reductions in proteinuria in chronic kidney disease in clinical trials, with cardiovascular safety guiding their use.