Effect of add-on direct renin inhibitor aliskiren in patients with non-diabetes related chronic kidney disease

BMC Nephrology

Research Article

Der-Cherng Tarng¹  Yung-Tai Chen²  Szu-yuan Li³  Wu-Chang Yang⁴  Chih-Yu Yang⁴  Chih-Ching Lin⁴  Wen-Sheng Liu⁵ 

[1] Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan;Department and Institute of Physiology, National Yang-Ming University, Taipei, Taiwan;Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan;Department of Medicine, Taipei City Hospital Heping Fuyou Branch, Taipei, Taiwan;Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan;Institute of Clinical of Medicine, National Yang-Ming University, Taipei, Taiwan;Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan;School of Medicine, National Yang-Ming University, Taipei, Taiwan;School of Medicine, National Yang-Ming University, Taipei, Taiwan;Division of Nephrology, Department of Medicine, Taipei City Hospital, Zhong-Xing Branch, Taipei, Taiwan;

关键词: Aliskiren;    Direct renin inhibitor;    Proteinuria;    CKD;   

DOI  :  10.1186/1471-2369-13-89

 received in 2012-02-02, accepted in 2012-07-12,  发布年份 2012

来源: Springer

【 摘 要 】

BackgroundThe renin-angiotensin-aldosterone system (RAAS) plays an important role in the progression of chronic kidney disease (CKD). Although dual RAAS inhibition results in worse renal outcomes than monotherapy in high risk type 2 diabetes patients, the effect of dual RAAS inhibition in patients with non-DM CKD is unclear. The aim of this study was to evaluate the potential renoprotective effect of add-on direct renin inhibitor in non-DM CKD patients.MethodsWe retrospectively enrolled 189 non-DM CKD patients who had been taking angiotensin II receptor blockers (ARBs) for more than six months. Patients were divided into an add-on aliskiren group and an ARB monotherapy group. The primary outcomes were a decline in glomerular filtration rate (GFR) and a reduction in urinary protein-to-creatinine ratio at six months.ResultsThe baseline characteristics of the two groups were similar. Aliskiren 150 mg daily reduced the urinary protein-to-creatinine ratio by 26% (95% confidence interval, 15 to 37%; p < 0.001). The decline in GFR was smaller in the add-on aliskiren group (−2.1 vs. -4.0 ml/min, p = 0.038). Add-on aliskiren had a neutral effect on serum potassium in the non-DM CKD patients. In subgroup analysis, the proteinuria-reducing effect of aliskiren was more prominent in patients with a GFR less than 60 ml/min, and in patients with a urinary protein-to-creatinine ratio greater than 1.8. The effect of aliskiren in retarding the decline in GFR was more prominent in patients with hypertensive nephropathy than in those with glomerulonephritis.ConclusionAdd-on direct renin inhibitor aliskiren (150 mg daily) safely reduced proteinuria and attenuated the decline in GFR in the non-DM CKD patients who were receiving ARBs.

【 授权许可】

Unknown   
© Chen et al.; licensee BioMed Central Ltd. 2012. This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.