Safety of enhanced renin-angiotensin-aldosterone system inhibition with aliskiren in nondiabetic patients with chronic kidney disease

被引:8
|
作者
Lizakowski, Slawomir [1 ]
Tylicki, Leszek [1 ]
Rutkowski, Przemyslaw [1 ,2 ]
Renke, Marcin [3 ]
Sulikowska, Beata [4 ]
Heleniak, Zbigniew [1 ]
Donderski, Rafal [4 ]
Bednarski, Rafal [4 ]
Przybylska, Milena [1 ]
Manitius, Jacek [4 ]
Rutkowski, Boleslaw [1 ]
机构
[1] Med Univ Gdansk, Dept Nephrol Transplantol & Internal Med, Gdansk, Poland
[2] Med Univ Gdansk, Dept Gen Nursing, Gdansk, Poland
[3] Med Univ Gdansk, Dept Occupat & Internal Dis, Gdansk, Poland
[4] Nicholas Copernicus Univ, Ludwik Rydygier Coll Med Bydgoszcz, Dept Nephrol Hypertens & Internal Dis, Bydgoszcz, Poland
来源
POLSKIE ARCHIWUM MEDYCYNY WEWNETRZNEJ-POLISH ARCHIVES OF INTERNAL MEDICINE | 2013年 / 123卷 / 05期
关键词
aliskiren; chronic kidney disease; proteinuria; renin-angiotensin-aldosterone system; ACE-INHIBITION; RECEPTOR ANTAGONIST; BLOCKADE;
D O I
10.20452/pamw.1726
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
INTRODUCTION Various methods of combination renin-angiotensin-aldosterone system blockade help achieve more potent antiproteinuric effects, but may be associated with higher risk of side effects. Therapies involving direct renin inhibitor, aliskiren, may promote renal fibrosis by stimulating (pro) renin receptor due to increased renin levels. OBJECTIVES The aim of the study was to compare the effects of combination treatment with angiotensin receptor blockers, telmisartan (80 mg/d) and aliskiren (300 mg/d) with those of combination treatment with 80 mg/d telmisartan and mineralocorticoid receptor blocker (50 mg/d eplerenone) and telmisartan (160 mg/d) alone on the urinary excretion of transforming growth factor beta(1) (TGF-beta(1)), renal function, and serum potassium levels. PATIENTS AND METHODS A randomized open-label controlled cross-over study was performed in 18 white patients (7 women and 11 men; mean age, 42.4 +/- 1.9 years) with proteinuric nondiabetic chronic kidney disease and estimated glomerular filtration rate of 85.2 +/- 4.6 ml/min. RESULTS The urinary excretion of TGF-beta(1) was stable despite a significant increase in plasma renin levels after treatment with telmisartan and aliskiren. There were no differences in renal function and serum potassium levels between the compared treatments. Moreover, there were no episodes of hypotension or acute renal impairment. CONCLUSIONS Combination therapy with telmisartan and aliskiren may be safe in young nondiabetic patients with normal renal function at low vascular risk. This treatment may be an alternative for a subset of patients in whom standard RAA system blockade is ineffective.
引用
收藏
页码:221 / 227
页数:7
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