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Assessment of Vascular Function in Patients With Chronic Kidney Disease
Published on: June 16, 2014
A retrospective Aliskiren and Losartan study in non-diabetic chronic kidney disease
Keng-Thye Woo1, Hui-Lin Choong, Kok-Seng Wong
1Keng-Thye Woo, Hui-Lin Choong, Kok-Seng Wong, Han- Kim Tan, Marjorie Foo, Grace SL Lee, Choong-Meng Chan, Department of Renal Medicine, Singapore General Hospital, 169608, Singapore.
Insights
Combination therapy with Aliskiren and Losartan in chronic kidney disease (CKD) patients reduced proteinuria but increased hyperkalemia risk. High-dose Losartan alone was more effective and safer for managing proteinuria in CKD.
Area of Science:
- Nephrology
- Pharmacology
- Internal Medicine
Background:
- Chronic kidney disease (CKD) affects millions globally, necessitating effective renoprotective strategies.
- Angiotensin receptor blockers (ARBs) and direct renin inhibitors (DRIs) are cornerstone therapies for managing CKD.
- Assessing combination therapies versus monotherapy is crucial for optimizing CKD treatment.
Purpose of the Study:
- To compare the efficacy and safety of combined Aliskiren and Losartan versus high-dose Losartan alone and Aliskiren alone in non-diabetic CKD patients.
- To evaluate the impact of these therapeutic regimens on proteinuria and estimated Glomerular Filtration Rate (eGFR).
Main Methods:
- Retrospective analysis of 143 non-diabetic CKD patients.
- Comparison of three groups: Combined Aliskiren (150 mg/d) and Losartan (100 mg/d); High-dose Losartan (200 mg/d); Aliskiren (150 mg/d) alone.
- Inclusion criteria: Treatment for at least 36 months, proteinuria ≥ 1 g, and CKD Stage 3.
- Primary renal endpoints: eGFR < 15 mL/min or end-stage renal failure.
Main Results:
- High-dose Losartan significantly reduced proteinuria compared to other groups (P < 0.007).
- All groups showed significant proteinuria reduction (P < 0.043, P < 0.001).
- No significant differences in eGFR changes or blood pressure were observed between groups.
- Hyperkalemia incidence was highest in the combined therapy group (14.2%) compared to Aliskiren alone (8.7%) and high-dose Losartan (6.3%) (P < 0.001).
Conclusions:
- Combination therapy with Aliskiren and Losartan demonstrated efficacy in reducing proteinuria in non-diabetic CKD.
- However, this combination was associated with a significantly higher prevalence of hyperkalemia, raising safety concerns.
- High-dose Losartan monotherapy appears to be a safer and effective alternative for proteinuria management in this patient population.
Aim:
To assess the efficacy of combined Aliskiren and Losartan vs high dose Losartan and Aliskiren alone in chronic kidney disease (CKD).
Methods:
This is a retrospective study of 143 patients with non-diabetic CKD comparing combined Aliskiren (150 mg/d) with Losartan (100 mg/d) therapy vs High dose Angiotensin receptor blockers (ARB) (Losartan 200 mg/d) and the third group Aliskiren (150 mg/d) alone. This study involved only patient medical records. Entry criteria included those patients who had been treated with the above drugs for at least 36 mo within the 5 years period; other criteria included proteinuria of 1 g or more and or CKD Stage 3 at the start of the 36 mo period. The study utilised primary renal end points of estimated Glomerular Filtration Rate (eGFR) < 15 mL/min or end stage renal failure.
Results:
Patients treated with high dose ARB compared to the other two treatment groups had significantly less proteinuria at the end of 36 mo (P < 0.007). All 3 groups had significant reduction of proteinuria (P < 0.043, P < 0.001). Total urinary protein was significantly different between the 3 groups over the 3-year study period (P = 0.008), but not eGFR. The changes in eGFR from baseline to each year were not significantly different between the 3 therapeutic groups (P < 0.119). There were no significant differences in the systolic and diastolic blood pressure between the 3 drug groups throughout the 3 years. The incidence of hyperkalemia (> 5.5 mmol/L) was 14.2% (7/49) in the Combined Aliskiren and ARB group, 8.7% (4/46) in the Aliskiren alone group and 6.3% (3/48) in the High dose ARB group (P < 0.001).
Conclusion:
This study in non-diabetic CKD patients showed that Combination therapy with Aliskiren and ARB was effective but was not safe as it was associated with a high prevalence of hyperkalaemia.
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