Is there a role for direct renin inhibitors in chronic kidney disease?
OBJECTIVE
To evaluate the evidence supporting the use of renin inhibitors to control hypertension, limit kidney disease progression, and decrease cardiovascular risk in patients with chronic kidney disease (CKD).


RESULTS
The literature on the subject is still limited. Most of the studies have used aliskiren as the study drug. Animal models show improved survival and decreased renal injury in animals receiving aliskiren. Human studies in patients with normal renal function show effective blood pressure control alone or in combination with different agents. There are no studies focusing on blood pressure control in patients with CKD, though the drug has been safely used in CKD. In a randomized clinical trial, aliskiren decreased albuminuria when added to losartan in patients with early diabetic nephropathy. Ongoing studies are evaluating the role of renin inhibitors in the prevention of cardiovascular events and slowing of kidney disease progression in CKD.


CONCLUSIONS
Renin inhibitors, specifically aliskiren, effectively decrease albuminuria. Their role in improving hard renal endpoints and decreasing cardiovascular events in CKD still remains to be established.
Peixoto
Aldo J
AJ
Medical Service, VA Connecticut Healthcare System, 111, 950 Campbell Avenue, West Haven, CT 06516, USA. aldo.peixoto@yale.edu
Orias
Marcelo
M
D000959:Antihypertensive Agents / Q000627:therapeutic use; D006801:Humans; D007668:Kidney / Q000473:pathology; D007676:Kidney Failure, Chronic / Q000188:drug therapy* / Q000473:pathology / Q000517:prevention & control; D012084:Renin-Angiotensin System / Q000187:drug effects; D000092502:Renin Inhibitors
D000959:Antihypertensive Agents; D000092502:Renin Inhibitors