Aliskiren and losartan trial in non-diabetic chronic kidney disease

Woo, Keng Thye; Choong, Hui Lin; Wong, Kok‐Seng; Tan, Hwee Leong; Foo, Marjorie; Fook‐Chong, Stephanie; Lee, Evan J.C.; Vathsala, A.; Lee, Grace S L; Chan, Choong-Meng

doi:10.1177/1470320313510584

Cited by 15 publications

(12 citation statements)

References 17 publications

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“…The aliskiren add-on therapy was well-tolerated in all of the patients, without any significant adverse events [35]. Opposite conclusions to the ALTITUDE study [32] and the study by Woo and colleagues [34] were reached by Wu et al [36] in their reports on CKD patients (eGFR: 37.4 mL/min/1.73 m 2 ). According to them, adding aliskiren to existing therapy with RAAS system blockade in both diabetic and non-diabetic CKD patients, had a favourable effect on reducing residual proteinuria and inadequately controlled BP, irrespective of CKD stage.…”

Section: Pharmacology Of Aliskirenmentioning

confidence: 71%

“…alone, but the incidence of hyperkalaemia was the highest (14.2%) in the combined aliskiren and losartan group [33]. Later, Woo et al [34] repeated their suggestion about the lack of beneficial effects and possible adverse effects of the addition of aliskiren to standard therapy with RAAS system blockade in non-diabetic CKD patients, based on a randomised trial in 155 patients with non-diabetic CKD (47-49 mL/min/1.73 m 2 ).…”

Section: Pharmacology Of Aliskirenmentioning

confidence: 99%

“…The combination therapy with aliskiren and losartan was as efficacious as aliskiren alone and losartan alone. Moreover, the incidence of hyperkalaemia was the highest (37.2%) in the combined aliskiren and losartan group, and there was one patient who developed a non-fatal stroke in this group while the other two groups had none [34]. Ohsawa et al [35] compared the effects of aliskiren (average dose of 176.5 daily) with benazepril, when added to ARB and other antihypertensives, on ambulatory BP and cardiorenal function in CKD (eGFR: 45.7-46.3 mL/min/1.73 m 2 ).…”

Section: Pharmacology Of Aliskirenmentioning

confidence: 99%

“…an increased incidence of nonfatal stroke, renal complications, hyperkalemia, and hypotension after 18-24 months of treatment [32]. Woo et al [33], based on their retrospective analysis, suggested that the findings of the ALTITUDE study would also apply to non-diabetic CKD patients. Patients with chronic glomerulonephritis (eGFR: 48-49 mL/min/1.73 m 2 ) subjected to combined aliskiren (150 mg/day) with losartan (100 mg/day) therapy, showed reduced proteinuria and BP as efficacious as aliskiren (150 mg/day) or losartan (200 mg/day) Tani et al 2016 aliskiren (300 mg) + existing antihypertensives hypertension in diabetic and non-diabetic nephropathy [39] Description and main results of the studies are provided in the text.…”

Section: Pharmacology Of Aliskirenmentioning

confidence: 99%

“…Later, Woo et al [34] repeated their suggestion about the lack of beneficial effects and possible adverse effects of the addition of aliskiren to standard therapy with RAAS system blockade in non-diabetic CKD patients, based on a randomised trial in 155 patients with non-diabetic CKD (47-49 mL/min/1.73 m 2 ). They examined the effects of aliskiren (150 mg/day) combined with losartan (100 mg/day), aliskiren (150 mg/day) alone, and losartan (100 mg/day) alone, on BP and proteinuria in CKD patients with chronic glomerulonephritis.…”

Section: Pharmacology Of Aliskirenmentioning

confidence: 99%

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Aliskiren – an antihypertensive renin inhibitor in the treatment of patients with chronic kidney disease

Łukawski¹,

Baranowicz-Gąszczyk²

2017

J Pre Clin Clin Res.

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Łukawski K, Baranowicz-Gąszczyk I. Aliskiren -an antihypertensive renin inhibitor in the treatment of patients with chronic kidney disease. J Pre-Clin Clin Res. 2017; 11(1): 81-85. doi: 10.26444/jpccr/75295 Abstract Introduction. The renin-angiotensin-aldosterone system (RAAS) plays an important role in the pathogenesis of hypertension, cardiovascular diseases (CVDs) and chronic kidney disease (CKD). Drugs affecting the RAAS system, such as angiotensinconverting enzyme (ACE) inhibitors and angiotensin II receptor blockers (ARBs), are commonly used in the treatment of hypertension and heart failure. These drugs are also effective in reducing proteinuria and may, at least, delay end-stage renal disease in both diabetic and non-diabetic proteinuric CKD. However, novel drugs are needed to more effectively suppress the RAAS system and the progression of CKD. Aliskiren is the first direct renin inhibitor which has been approved for the treatment of hypertension. Additionally, a number of clinical studies have shown the antiproteinuric effect of aliskiren.Objective. This review focuses on the antihypertensive and antiproteinuric effects of aliskiren in patients with CKD. The pharmacology of aliskiren in these patients is also provided. Conclusions. Aliskiren-based hard endpoint large trials in non-diabetic nephropathy are needed in order to clarify the use of aliskiren in CKD patients.

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Section: Pharmacology Of Aliskirenmentioning

confidence: 71%

Section: Pharmacology Of Aliskirenmentioning

confidence: 99%

Section: Pharmacology Of Aliskirenmentioning

confidence: 99%

Section: Pharmacology Of Aliskirenmentioning

confidence: 99%

Section: Pharmacology Of Aliskirenmentioning

confidence: 99%

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Aliskiren – an antihypertensive renin inhibitor in the treatment of patients with chronic kidney disease

Łukawski¹,

Baranowicz-Gąszczyk²

2017

J Pre Clin Clin Res.

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Direct inhibition of plasmatic renin activity with aliskiren: a promising but under-investigated therapeutic option for non-diabetic glomerulonephritis

et al. 2015

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Non-diabetic glomerulonephritis is a frequent cause of end-stage renal disease. The use of renin-angiotensin-aldosterone system blockers is a fundamental therapeutic approach. However, converting enzyme inhibitors (ACE-is) and angiotensin receptor blockers do not always achieve the desired target of proteinuria. The induction of the prorenin and renin up-regulation is a possible explanation. Aliskiren is the first drug acting as direct inhibitor of plasmatic renin activity, also able to interfere with the prorenin and renin profibrotic escape. We aimed at reviewing the literature for the assessment of potential efficacy and safety of aliskiren in the treatment of non-diabetic glomerulonephritis. The data on this topic are limited; however, we concluded for a possible usefulness of aliskiren. The renal safety profile appears potentially acceptable in non-diabetic patients although extreme carefulness, particularly with respect to long-term renal and cardiovascular tolerability, is recommended.

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Treatments for Chronic Kidney Disease: A Systematic Literature Review of Randomized Controlled Trials

Sánchez

Thompson²,

Scott³

et al. 2021

Adv Ther

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Delaying disease progression and reducing the risk of mortality are key goals in the treatment of chronic kidney disease (CKD). New drug classes to augment renin-angiotensin-aldosterone system (RAAS) inhibitors as the standard of care have scarcely met their primary endpoints until recently. This systematic literature review explored treatments evaluated in patients with CKD since 1990 to understand what contemporary data add to the treatment landscape. Eighty-nine clinical trials were identified that had enrolled patients with estimated glomerular filtration rate 13.9-102.8 mL/ min/1.73 m 2 and urinary albumin-to-creatinine ratio (UACR) 29.9-2911.0 mg/g, with (75.5%) and without (20.6%) type 2 diabetes (T2D). Clinically objective outcomes of kidney failure and all-cause mortality (ACM) were reported in 32 and 64 trials, respectively. Significant reductions (P \ 0.05) in the risk of kidney failure were observed in seven trials: five small trials published before 2008 had evaluated the RAAS inhibitors losartan, benazepril, or ramipril in patients with (n = 751) or without (n = 84-436) T2D; two larger trials (n = 2152-2202) published onwards of 2019 had evaluated the sodium-glucose co-transporter 2 (SGLT2) inhibitors canagliflozin (in patients with T2D and UACR [ 300-5000 mg/g) and dapagliflozin (in patients with or without T2D and UACR 200-5000 mg/g) added to a background of RAAS inhibition. Significant reductions in ACM were observed with dapagliflozin in the DAPA-CKD trial. Contemporary data therefore suggest that augmenting RAAS inhibitors with new drug classes has the potential to improve clinical outcomes in a broad range of patients with CKD.

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Aliskiren and losartan trial in non-diabetic chronic kidney disease

Cited by 15 publications

References 17 publications

Aliskiren – an antihypertensive renin inhibitor in the treatment of patients with chronic kidney disease

Aliskiren – an antihypertensive renin inhibitor in the treatment of patients with chronic kidney disease

Direct inhibition of plasmatic renin activity with aliskiren: a promising but under-investigated therapeutic option for non-diabetic glomerulonephritis

Treatments for Chronic Kidney Disease: A Systematic Literature Review of Randomized Controlled Trials

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