Aliskiren Reduces Proteinuria Through Changes in Central and Peripheral Hemodynamics in Chronic Kidney Disease Patients

Recently, a newly developed direct rennin inhibitor (DRI), aliskiren, has been shown to have a persistent depressor action throughout the day in hypertensive patients. However, only a few reports compared Reno protection by aliskiren to angiotensinogen receptor blockers (ARBs) in proteinuric chronic kidney disease (CKD) patients. Methods: Measurements of urinary protein excretion (Upro) were carried out before and 6 months after the change from other ARBs to aliskiren. Twenty three patients who persistently had values of Up ro >1.0 g daily despite the treatment with antihypertensive drugs including ARBs were considered as candidates. Initially, aliskiren was started at 150 mg once daily in the evening, and increased up to 300 mg once daily in the evening. Home BP was utilized for determination of BP control. In addition to BP measurements, pulse wave velocity (PWV) and second SBP (SBP2), an index of central BP, were evaluated before and 6 months after aliskiren administration. Renal function was evaluated by estimated glomerular filtration rate (eGFR). Results: Administration of aliskiren reduced Upro (2.16 ± 0.91 to 1.62 ± 1.08 g/day, P<0.05), accompanied with decreases in systolic BP, SBP2 and PWV. Moreover, reduction of Upro was positively correlated with those of changes in SBP (r=0.46, P<0.05), SBP2 (r=0.48, p<0.05) and PWV (r=0.48, P<0.05). Renal dysfunction evaluated by eGFR did not progress during the study period (before 70.46 ± 9.56, after 68.00 ± 12.24 ml/min/1.73m2). Conclusion: The results of the present study suggest that aliskiren exerted its renoprotective action through improvement of central and peripheral hemodynamics.