International Urology and Nephrology

, Volume 44, Issue 3, pp 841–845 | Cite as

Beneficial effect of aliskiren combined with olmesartan in reducing urinary protein excretion in patients with chronic kidney disease

  • Takahito Moriyama
  • Yuki Tsuruta
  • Chiari Kojima
  • Mitsuyo Itabashi
  • Hidekazu Sugiura
  • Takashi Takei
  • Tetsuya Ogawa
  • Keiko Uchida
  • Ken Tsuchiya
  • Kosaku Nitta
Nephrology – Original Paper

Abstract

Background

Blockade of the renin–angiotensin–aldosterone system is a therapeutic mainstay in patients with chronic kidney disease (CKD). However, the renoprotective effect of the novel direct renin inhibitor aliskiren is unknown.

Materials and methods

We performed a prospective study in 10 CKD patients. All 10 patients with persistent proteinuria (urinary protein-to-creatinin ratio 0.3–3.5 g/g), despite good blood pressure control (<130/80 mmHg) with olmesartan, were started on 150 mg/day aliskiren. Clinical parameters were examined before and after 4, 8, 12, and 16 weeks of treatment.

Results

Urinary protein-to-creatinine ratio significantly decreased by about 40% at 16 weeks from baseline (P = 0.0002), although estimated glomerular filtration rate and blood pressure did not change throughout the study period. Plasma renin activity also decreased significantly from baseline (P = 0.019), although plasma aldosterone concentration did not change.

Conclusions

Aliskiren combined with olmesartan reduces proteinuria in CKD patients.

Keywords

Aliskiren Chronic kidney disease Olmesartan Proteinuria 

References

  1. 1.
    Jafar TH, Schmid CH, Landa M, Giatras I, Toto R, Remuzzi G, Maschio G, Brenner BM, Kamper A, Zucchelli P, Becker G, Himmelmann A, Bannister K, Landais P, Shahinfar S, de Jong PE, de Zeeuw D, Lau J, Levey AS (2001) Angiotensin-converting enzyme inhibitors and progression of nondiabetic renal disease. A meta-analysis of patient-level data. Ann Intern Med 135:73–87PubMedGoogle Scholar
  2. 2.
    The GISEN Group (Gruppo Italiano di Studi Epidemiologici in Nefrologia) (1997) Randomised placebo-controlled trial of effect of ramipril on decline in glomerular filtration rate and risk of terminal renal failure in proteinuric, non-diabetic nephropathy. Lancet 349:1857–1863CrossRefGoogle Scholar
  3. 3.
    Schmieder RE, Klingbeil AU, Fleischmann EH, Veelken R, Delles C (2005) Additional antiproteinuric effect of ultrahigh dose candesartan: a double-blind, randomized, prospective study. J Am Soc Nephrol 16:3038–3045PubMedCrossRefGoogle Scholar
  4. 4.
    Hou FF, Zhang X, Zhang GH, Xie D, Chen PY, Zhang WR, Jiang JP, Liang M, Wang GB, Liu ZR, Geng RW (2006) Efficacy and safety of benazepril for advanced chronic renal insufficiency. N Engl J Med 354:131–140PubMedCrossRefGoogle Scholar
  5. 5.
    Casas JP, Chua W, Loukogeorgakis S, Vallance P, Smeeth L, Hingorani AD, MacAllister RJ (2005) Of inhibitors of the rennin-angiotensin system and other antihypertensive drugs on renal outcomes: systematic review and meta-analysis. Lancet 366:2026–2033PubMedCrossRefGoogle Scholar
  6. 6.
    Toto RD (2008) Treatmemt of hypertension in chronic kidney disease. Semin Nephrol 25:435–439CrossRefGoogle Scholar
  7. 7.
    Paving HH, Persson F, Lewis JB, Lewis EJ, Hollenberg NK (2008) Aliskiren combined with losartan in type 2 diabetes and nephropathy. N Engl J Med 358:2433–2446CrossRefGoogle Scholar
  8. 8.
    Persson F, Rossing P, Reinhard H, Juhl T, Stehouwer CDA, Schalkwijk C, Danser AHJ, Boomsam F, Frandsen E, Parving HH (2009) Renal effcts of aliskiren compared with and in combination with irbesartan in patients with type 2 diabetes, hypertension, and albuminuria. Diabetes Care 32:1873–1879PubMedCrossRefGoogle Scholar
  9. 9.
    Ito S, Nakura N, Breton SL, Keefe D (2010) Effecacy and safety of aliskiren in Japanese hypertensive patients with renal dysfunction. Hypertens Res 33:62–66PubMedCrossRefGoogle Scholar
  10. 10.
    Fisher ND, Jan Danser AHJ, Nussberger J, Dole WP, Hollenberg NK (2008) Renal and hormonal responses to direct reninin hibition with aliskiren in healthy humans. Hypertension 117:3199–3205Google Scholar
  11. 11.
    Mann JF, Schmieder RE, McQueen M, Dyal L, Schumacher H, Pogue J, Wang X, Maggioni A, Budaj A, Chaithiraphan S, Dickstein K, Keltai M, Metsärinne K, Oto A, Parkhomenko A, Piegas LS, Svendsen TL, Teo KK, Yusuf S, ONTARGET investigators (2008) Renal outcomes with telmisartan, ramipril, or both, in people at high vascular risk (the ONTARGET study): a multicentre, randomized, double-blind, controlled trial. Lancet 372:547–553PubMedCrossRefGoogle Scholar
  12. 12.
    Lewis EJ, Hunsicker LG, Clarke WR, Berl T, Pohl MA, Lewis JB, Ritz E, Atkins RC, Rohde R, Raz I, Collaborative Study Group (2001) Renoprotective effect of the angiotensin-receptor antagonist irbesartan in patients with nephropathy due to type 2 diabetes. N Engl J Med 345:851–860PubMedCrossRefGoogle Scholar
  13. 13.
    Suissa S, Hutchinson T, Brophy JM, Kezouh A (2006) ACE-inhibitor use and the long-term risk of renal failure in diabetes. Kidney Int 69:913–919PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, B.V. 2011

Authors and Affiliations

  • Takahito Moriyama
    • 1
  • Yuki Tsuruta
    • 1
  • Chiari Kojima
    • 1
  • Mitsuyo Itabashi
    • 1
  • Hidekazu Sugiura
    • 1
  • Takashi Takei
    • 1
  • Tetsuya Ogawa
    • 1
  • Keiko Uchida
    • 1
  • Ken Tsuchiya
    • 1
  • Kosaku Nitta
    • 1
  1. 1.Department of Medicine, Kidney CenterTokyo Women’s Medical UniversityTokyoJapan

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