title: Are we ready to use aliskiren in children?
abstract: The objective of this case series was to review the safety and efficacy of aliskiren in combination with losartan in pediatric chronic kidney disease (CKD) patients. This was a retrospective study in which the medical files of all patients who had received aliskiren were reviewed. Four patients were identified between 5 and 18 years of age who had received aliskiren and losartan for the reduction of refractory proteinuria. While proteinuria was reduced in all four of these patients by 45, 96, 53, and 64%, respectively, three patients experienced side effects requiring changes in the aliskiren dose. A significant side effect occurred in the patient with CKD stage 3 who suffered accelerated loss of kidney function leading to dialysis after only a short course of therapy. The data from this preliminary trial strongly suggest that clinicians should exercise caution when prescribing aliskiren in combination with losartan until appropriate pediatric trials establish dosing, efficacy, and safety.
authors.affiliation: Department of Pediatrics, Children's Hospital, London Health Sciences Centre, University of Western Ontario, 800 Commissioners Road East, London, N6A 5W9, ON, Canada.
authors.forename: Erin Elizabeth
authors.initials: EE
authors.lastname: Kelland
authors.forename: Leanne Michelle
authors.initials: LM
authors.lastname: McAuley
authors.forename: Guido
authors.initials: G
authors.lastname: Filler
mesh_terms: D000293:Adolescent; D000367:Age Factors; D000577:Amides / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D047228:Angiotensin II Type 1 Receptor Blockers / Q000627:therapeutic use; D002675:Child, Preschool; D002908:Chronic Disease; D004305:Dose-Response Relationship, Drug; D004359:Drug Therapy, Combination; D005260:Female; D005650:Fumarates / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D007674:Kidney Diseases / Q000150:complications / Q000188:drug therapy* / Q000378:metabolism; D019808:Losartan / Q000627:therapeutic use; D008297:Male; D056687:Off-Label Use; D018579:Patient Selection; D011507:Proteinuria / Q000188:drug therapy* / Q000209:etiology / Q000378:metabolism; D012084:Renin-Angiotensin System / Q000187:drug effects; D018570:Risk Assessment; D012307:Risk Factors; D016896:Treatment Outcome; D000092502:Renin Inhibitors
chemical_list: D000577:Amides; D047228:Angiotensin II Type 1 Receptor Blockers; D005650:Fumarates; D019808:Losartan; D000092502:Renin Inhibitors; C446481:aliskiren