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Effect of direct renin inhibitor monotherapy on proteinuria in overt diabetic nephropathy

Somrutat Silaratana1, Sangduen Sumransurp, Soodkate Duangchana

  • 1Nephrology Unit, Department of Medicine, Faculty of Medicine, Thammasat University, Klong Nung, Klong Luang, Pathumtani, Thailand.

Journal of the Medical Association of Thailand = Chotmaihet Thangphaet
|August 23, 2013
PubMed
Abstract

Insights

Aliskiren, a direct renin inhibitor, effectively reduced blood pressure and proteinuria in patients with diabetic nephropathy. This treatment demonstrated good tolerability and safety, offering a promising option for managing this condition.

Area of Science:

  • Nephrology
  • Endocrinology
  • Pharmacology

Background:

  • Diabetic nephropathy is a leading cause of chronic kidney disease (CKD) and end-stage renal disease.
  • Inhibition of the renin-angiotensin-aldosterone system (RAAS) via ACE inhibitors and ARBs can slow CKD progression.
  • Direct renin inhibitors (DRIs) offer theoretical complete RAAS blockade by reducing renin activity.

Purpose of the Study:

  • To evaluate the efficacy of aliskiren, a direct renin inhibitor (DRI), as monotherapy.
  • To assess aliskiren's impact on blood pressure control in patients with diabetic nephropathy.
  • To determine the effect of aliskiren on proteinuria reduction in overt diabetic nephropathy.

Main Methods:

  • Diabetic mellitus patients with eGFR ≥ 30 ml/min and proteinuria > 300 mg/day were enrolled.
  • Participants received aliskiren 150 mg/day for 2 weeks, followed by 300 mg/day for 24 weeks.
  • Blood pressure, proteinuria (UPCR), serum creatinine, eGFR, and serum potassium were monitored.

Main Results:

  • Significant reductions in systolic blood pressure (SBP) and diastolic blood pressure (DBP) were observed throughout the 24-week treatment period.
  • Aliskiren treatment led to a significant reduction in urine protein-to-creatinine ratio (UPCR) by 45% at 24 weeks.
  • No significant changes in serum creatinine, eGFR, or serum potassium were noted; no harmful adverse reactions were reported.

Conclusions:

  • Aliskiren monotherapy effectively controls blood pressure in patients with overt diabetic nephropathy.
  • Aliskiren significantly reduces proteinuria in this patient population.
  • The treatment demonstrated a favorable safety profile with no significant adverse effects.

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