Exp Clin Endocrinol Diabetes 2018; 126(01): 39-52
DOI: 10.1055/s-0043-106440
Article
© Georg Thieme Verlag KG Stuttgart · New York

Dual RAAS Blockade with Aliskiren in Patients with Severely Impaired Chronic Kidney Disease

Franz Maximilian Rasche
1   Department of Internal Medicine, Neurology, Dermatology, Clinic for Endocrinology, Diabetology and Nephrology, University Leipzig, Leipzig, Germany
,
Claudia Joel
1   Department of Internal Medicine, Neurology, Dermatology, Clinic for Endocrinology, Diabetology and Nephrology, University Leipzig, Leipzig, Germany
,
Thomas Ebert
1   Department of Internal Medicine, Neurology, Dermatology, Clinic for Endocrinology, Diabetology and Nephrology, University Leipzig, Leipzig, Germany
,
Thomas Frese
2   Institute of General Practice and Family Medicine, Martin-Luther-University Halle/Wittenberg, Germany
,
Filip Barinka
3   Center for Geriatric Medicine at Bezirksklinikum Regensburg, Regensburg, Germany
,
Volker Busch
3   Center for Geriatric Medicine at Bezirksklinikum Regensburg, Regensburg, Germany
,
Wilma Gertrud Rasche
4   Department of Head Medicine and Oral Health, Department of Ophthalmology, University Leipzig, Leipzig, Germany
,
Tom H. Lindner
1   Department of Internal Medicine, Neurology, Dermatology, Clinic for Endocrinology, Diabetology and Nephrology, University Leipzig, Leipzig, Germany
,
Jochen Schneider*
5   Translational & Experimental Medicine, Luxembourg Centre de Systems Biomedicine, Luxembourg
6   Department of Internal Medicine II, Saarland University, Homburg Saar, Germany
,
Stephan Schiekofer*
3   Center for Geriatric Medicine at Bezirksklinikum Regensburg, Regensburg, Germany
› Author Affiliations
Further Information

Publication History

received 24 January 2017
revised 07 March 2017

accepted 15 March 2017

Publication Date:
27 April 2017 (online)

Abstract

Introduction

Dual renin-angiotensin-aldosterone blockade (dRAASb) is purposed in the prevention of the cardiorenal syndrome (CRS). However, all attempts with dRAASb even in patients with moderate impaired chronic kidney disease (CKD) were terminated due to the typical severe adverse events (SAE), e. g., hyperkalemia and rise of serum creatinine. The aim of our study with the direct renin inhibitor aliskiren was to evaluate the effect of dRAASb with a washout phase in patients with severely advanced CKD.

Patients and Methods

We have studied 45 patients (G3b to 4, A2 and >A3; median glomerular filtration rate (GFR) CKD-EPI 31 (23–40) ml/min per 1.73 m² BSA (body surface area), albumin-creatinine-ratio in urine (UACR) (0.413 (0.164 to 1.39) g/g) and proteinuria (0.5 (0.2 to 0.9) g/l) before, with and without aliskiren (150 respectively 300 mg per day) added to an angiotensin-converting enzyme inhibitor (ACEi) or an AT1-receptor blocker (ARB) over 4 ½ years.

Results

The dRAASb with aliskiren showed a significant decrease of proteinuria (0.5 to 0.38 g/l), especially in patients with an UACR≥350 mg/g and in the subgroup analysis e. g., in patients with diabetes, but proteinuria increased in the washout phase again. The blood pressure (130/80 mm Hg), serum potassium (4.9 to 5.0 mmol/l) and GFR remained nearly constant (31 to 29.5 ml/min per 1.73 m2 BSA). A more than 30% increase in serum creatinine was associated with an UACR>300 mg/g.

Conclusions

The dRAASb has beneficial effects on proteinuria and is safe in patients with severely advanced CKD. However, in patients with high UACR (>300 mg/g) raise of creatinine and potassium have to be controlled.

* Both authors contributed equally


Supplementary Material