Addition of aliskiren to olmesartan ameliorates tubular injury in chronic kidney disease patients partly by reducing proteinuria.

Abstract

INTRODUCTION:

Tubular injury is more important than glomerulopathy for renal prognosis in chronic kidney disease (CKD) patients. Numerous studies have demonstrated the active participation of the renin-angiotensin system (RAS) in CKD. However, whether addition of aliskiren, a direct renin inhibitor, to olmesartan improves renal tubular injury in CKD patients is unknown.

METHODS:

This study compared the effects of aliskiren (300 mg daily), olmesartan (40 mg daily), and its combination therapy on urinary L-fatty acid binding protein (L-FABP), a marker of tubular injury in stage I or II CKD patients. It also examined which clinical variables were independently correlated with tubular damage.

RESULTS:

Olmesartan or aliskiren monotherapy for 6 months comparably decreased blood pressure (BP) and proteinuria. BP and proteinuria levels were reduced more by combination therapy than by either monotherapy. Olmesartan or aliskiren decreased urinary L-FABP level, and combination therapy produced more incremental reduction in L-FABP level relative to each monotherapy. Multiple stepwise regression analysis revealed that BMI, low-density lipoprotein (LDL)-cholesterol and proteinuria were independently related to urinary L-FABP level.

CONCLUSIONS:

The present study demonstrated that addition of aliskiren to olmesartan decreased urinary L-FABP level partly via reduction of proteinuria in stage I or II CKD patients.

• Authors: Tsukasa Nakamura, Eiichi Sato, Mayuko Amaha, Yasuhiro Kawagoe, Sayaka Maeda, Sho-ichi Yamagishi
• Journal: Journal of the renin-angiotensin-aldosterone system : JRAAS (J Renin Angiotensin Aldosterone Syst) Vol. 13 Issue 1 Pg. 122-7 (Mar 2012) ISSN: 1752-8976 [Electronic] England
• PMID: 21946392 (Publication Type: Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)

Chemical References

• Amides
• Antihypertensive Agents
• Fatty Acid-Binding Proteins
• Fumarates
• Imidazoles
• Tetrazoles
• aliskiren
• olmesartan

Topics

• Adult
• Amides (pharmacology, therapeutic use)
• Antihypertensive Agents (pharmacology, therapeutic use)
• Blood Pressure (drug effects)
• Drug Therapy, Combination
• Fatty Acid-Binding Proteins (urine)
• Female
• Fumarates (pharmacology, therapeutic use)
• Humans
• Imidazoles (pharmacology, therapeutic use)
• Kidney Failure, Chronic (complications, drug therapy, physiopathology, prevention & control)
• Kidney Tubules (drug effects, pathology)
• Male
• Proteinuria (complications, drug therapy, physiopathology, prevention & control)
• Regression Analysis
• Tetrazoles (pharmacology, therapeutic use)