Add-On Aliskiren in Non-Dialysis CKD Patients Treated with Dual Blockade of Renin-Angiotensin System (RAS): A Prospective Pilot Study

The additive antiproteinuric effects of CEI+ARB are limited in most CKD pts possibly due to escape mechanisms. We evaluated antiproteinuric efficacy of direct renin inhibitor aliskiren in CKD pts with residual proteinuria after dual RAS blockade. We selected consecutive adult CKD stage 1-4 (no transplant) pts with proteinuria >0.5 g/d treated with CEI+ ARB at maximal tolerated dose unchanged in the previous 3 months. Immunosuppressive therapy, sK >5.5 mEq/L and eGFR change >30% in the previous 6 months were exclusion criteria. Patients were evaluated before (baseline) and during 6 months of aliskiren at a dose titrated to 300 mg/d. Out of the 50 selected pts, 5 did not complete the study (immunosuppressive therapy, n=2; no assumption of aliskiren, n=3). Age was 57±15 yrs and BMI 30±6 kg/m2; prevalence of males, diabetes and prior CV disease was 78%, 49% and 33%, respectively. Main changes in the 45 pts studied Basal month 1 month 3 month 6 P Systolic BP (mmHg) 146±13 139±13 139±16 141±19 0.0002 Diastolic BP (mmHg) 86±8 83±7 82±9 80±9 0.005 eGFR (mL/min/1.73 m2) 47.7±26.5 46.6±27.3 45.7±27.8 44.2±26.3 0.004 sK (mEq/L) 4.7±0.5 4.8±0.5 4.8±0.5 4.8±0.6 0.167 Proteinuria (g/d) 3.39±2.25 2.94±2.07 2.99±2.41 2.69±1.98 0.03