Goldsmith_EU_Renal 9/7/07 9:53 am Page 43
Direct Renin Inhibitors – Nuance or Necessity?
In six patients with renal dysfunction, a short-acting renin inhibitor – Finally, other DRIs are expected to join aliskiren in clinical use in the years
remikiren – reduced proteinuria by 27% (range -18 to -38%; p<0.01) to come, seeing that some of these new agents are currently undergoing
from a median baseline level of 5.8g/day.
Preliminary data from an animal and pre-clinical investigation.
ongoing clinical study indicate a more substantial reduction in
microalbuminuria with aliskiren (-61%) compared with ramipril (-50%).
DRIs may have a future as renoprotective agents besides their
antihypertensive usefulness, but at the moment it is much too early to be
Conclusion more than just interested in this class of agent. Crucially, this type of drug
In the next few years, the results of the first phase III trials with aliskiren needs to be able to demonstrate not only BP-lowering effects, which are
in patients with CKD will become available. The ongoing Aliskiren in the useful for all patients with chronic kidney disease, but also an ability to
Evaluation of Proteinuria in Diabetes (AVOID) study is a six-month study reduce proteinuria at least to the extent predicted by BP fall. The ability
of aliskiren in addition to losartan in 496 patients with controlled to decrease renin concentration and PRA, the more complete inhibition
hypertension, type 2 diabetes and proteinuria. The primary end-point is of the RAAS, the expected limitation of Ang II and aldosterone escape
the urinary albumin to creatinine ratio. Aliskiren Trial in Type 2 Diabetic phenomena and the prevention of possible renal-damaging direct effects
Nephropathy (ALTITUDE) is a type 2 diabetes outcomes study that will be of renin make aliskiren an appealing drug for nephrologists once the
carried out in approximately 6,000 subjects to determine whether pivotal information about change in plasma potassium, urinary protein
aliskiren delays time to diabetic complications in patients with diabetes and the GFR of patients is known in cohorts representative of the typical
mellitus and nephropathy.
older renal patients. ■
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