Effect of aliskiren in chronic kidney disease patients with refractory
hypertension undergoing hemodialysis: a randomized controlled multicenter study.
Author(s): Kuriyama S(1), Yokoyama K, Hara Y, Sugano N, Yokoo T, Hosoya T.
Affiliation(s): Author information:
(1)Division of Kidney and Hypertension, Department of Internal Medicine, Jikei
University School of Medicine, 3-25-8 Nishi-shinbashi, Minato-ku, Tokyo,
105-8461, Japan, kuriyamas218@yahoo.co.jp.
Publication date & source: 2014, Clin Exp Nephrol. , 18(5):821-30
BACKGROUND: Applying a direct renin inhibitor (DRI) to advanced stage chronic
kidney disease (CKD) patients is a matter of controversy. The purpose of this
study was to evaluate the effect of the DRI, aliskiren, in patients with
therapy-resistant hypertension undergoing hemodialysis (HD).
METHODS: The study was a prospective, randomized multicenter trial exploring the
antihypertensive effect of aliskiren in comparison with amlodipine, a calcium
channel blocker, in patients undergoing HD. A total of 83 participants whose
blood pressure (BP) had previously been treated with more than one
antihypertensive agent and not having achieved the BP goal of <140/90 mmHg were
randomly assigned to either aliskiren 150 mg or amlodipine 5 mg as an add-on
therapy.
RESULTS: A significant decrease in pre-dialysis clinic BP and home BP was found
only in the amlodipine group and not in the aliskiren group. In contrast, there
was a significant decrease in atrial natriuretic peptide (ANP) in the aliskiren
group but not in the amlodipine group. N-terminal pro-B-type natriuretic hormone
remained unchanged in both groups. Aliskiren significantly reduced angiotensin I
and II, plasma renin activity, and increased plasma renin content. However, such
changes were not observed in the amlodipine group.
CONCLUSION: Amlodipine, not aliskiren, effectively reduces BP in CKD patients
with refractory hypertension undergoing HD. Aliskiren suppresses the
renin-angiotensin system and reduces ANP. Whether the DRI is beneficial in
improving cardiovascular events in patients undergoing HD remains to be
elucidated in future studies.
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