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

Franz Maximilian Rasche; Claudia Joel; Thomas Ebert; Thomas Frese; Filip Barinka; Volker Busch; Wilma Gertrud Rasche; Tom H. Lindner; Jochen Schneider; Stephan Schiekofer

doi:10.1055/s-0043-106440

Experimental and Clinical Endocrinology & Diabetes, Inhaltsverzeichnis

Exp Clin Endocrinol Diabetes 2018; 126(01): 39-52
DOI: 10.1055/s-0043-106440

Article

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

Authors

Franz Maximilian Rasche

¹Department of Internal Medicine, Neurology, Dermatology, Clinic for Endocrinology, Diabetology and Nephrology, University Leipzig, Leipzig, Germany
Claudia Joel

¹Department of Internal Medicine, Neurology, Dermatology, Clinic for Endocrinology, Diabetology and Nephrology, University Leipzig, Leipzig, Germany
Thomas Ebert

¹Department of Internal Medicine, Neurology, Dermatology, Clinic for Endocrinology, Diabetology and Nephrology, University Leipzig, Leipzig, Germany
Thomas Frese

²Institute of General Practice and Family Medicine, Martin-Luther-University Halle/Wittenberg, Germany
Filip Barinka

³Center for Geriatric Medicine at Bezirksklinikum Regensburg, Regensburg, Germany
Volker Busch

³Center for Geriatric Medicine at Bezirksklinikum Regensburg, Regensburg, Germany
Wilma Gertrud Rasche

⁴Department of Head Medicine and Oral Health, Department of Ophthalmology, University Leipzig, Leipzig, Germany
Tom H. Lindner

¹Department of Internal Medicine, Neurology, Dermatology, Clinic for Endocrinology, Diabetology and Nephrology, University Leipzig, Leipzig, Germany
Jochen Schneider^*

⁵Translational & Experimental Medicine, Luxembourg Centre de Systems Biomedicine, Luxembourg

⁶Department of Internal Medicine II, Saarland University, Homburg Saar, Germany
Stephan Schiekofer^*

³Center for Geriatric Medicine at Bezirksklinikum Regensburg, Regensburg, Germany

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.

Key words

dual RAAS blockade - aliskiren - adverse events - arterial hypertension - proteinuria - kidney function - diabetes mellitus

Volltext

Referenzen

References
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