title: Successful treatment of hypertension in anuric hemodialysis patients with a direct Renin inhibitor, aliskiren.
abstract: OBJECTIVE
  A direct renin-inhibitor (DRI), aliskiren, was administered to anuric patients to investigate whether it can be a new optional therapy against hypertension in hemodialysis (HD) patients.
  
  
  METHODS
  The patients that received aliskiren comprised 8 males and 2 females with a mean ± SD age of 63 ± 8 years (43-72 years). They were exposed to dialysis therapy for 118 ± 73 months (8-251 months), with diabetes mellitus in 4 cases, chronic glomerulonephritis in 4 cases, and other diagnoses in 2 cases.
  
  
  METHODS
  After the plasma renin activity (PRA) and plasma aldosterone concentration (PAC) were measured before an HD session, aliskiren, 150 mg as an initial dose, was administered to the patients. PRA and PAC were also examined a week after initiating aliskiren. The blood pressure (BP) levels at the start of each HD session for a period of 2 weeks (6 HD sessions) were compared between before and after administration of aliskiren. The change of doses in other antihypertensive agents was also counted.
  
  
  RESULTS
  The averaged reduction of mean blood pressure was 4 ± 5 mmHg, and doses of antihypertensives other than aliskiren were reduced in 4 patients. Of the examined parameters, only the reduction rate of PRA x PAC seemed correlated with the BP lowering effect of aliskiren, which was calculated as the sum of the mean BP reduction in mmHg and drug reduction with 1 tablet (capsule)/day considered to be 10 mmHg.
  
  
  CONCLUSIONS
  A DRI, aliskiren, was effective even in anuric dialysis patients, and monitoring of PRA and PAC was valuable for selecting cases responsive to aliskiren.
authors: Nephrology Division, Department of Internal Medicine, JA Toride Medical Center, Japan.
authors: Yoshitaka
authors: Y
authors: Maeda
authors: Nephrology Division, Department of Internal Medicine, JA Toride Medical Center, Japan.
authors: Yuya
authors: Y
authors: Araki
authors: Nephrology Division, Department of Internal Medicine, JA Toride Medical Center, Japan.
authors: Tomomi
authors: T
authors: Uno
authors: Nephrology Division, Department of Internal Medicine, JA Toride Medical Center, Japan.
authors: Keisuke
authors: K
authors: Nishigaki
authors: Nephrology Division, Department of Internal Medicine, JA Toride Medical Center, Japan.
authors: Naoto
authors: N
authors: Inaba
keywords: antihypertensive drugs; prorenin; vascular RAS
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