Aliskiren attenuates oxidative stress and improves tubular status in non-diabetic patients with chronic kidney disease-Placebo controlled, randomized, cross-over study

Purpose: Pharmacological inhibition of the renin-angiotensin-aldosteron system (RAAS) may have a beneficial impact on proteinuria and chronic kidney diseases (CKD) progression. Despite recent progress by means of angiotensin-converting enzyme inhibitors (ACEI) and angiotensin II receptor blockers (ARB), there is still no optimal therapy which can stop progression of the nephropathy. Recently introduced aliskiren is the first orally bioavailable direct renin inhibitor approved for the treatment of hypertension. The purpose was to evaluate the extent of oxidative stress and tubular injury after the direct renin inhibitor, aliskiren compared with placebo and perindopril in patients with non-diabetic chronic kidney disease (NDCKD). Material/methods: A randomized, double-blind, cross-over trial was performed in 14 patients receiving 300 mg aliskiren, 10 mg perindopril and placebo in random order. The end point was a change in the urinary excretion of N-acetyl-beta-D-glucosaminidase (NAG) and alpha 1-microglobulin (alpha 1m) and 15-F-2 alpha-isoprostane. Results: Aliskiren reduced excretion of 15-F-2 alpha-isoprostane (p = 0.03) and alpha 1m (p = 0.01) as compared to placebo. There were no differences between aliskiren and perindopril in this regard. NAG urine excretion did not change after aliskiren and perindopril. Conclusions: Aliskiren attenuates oxidative stress and may improve functional status of tubules in patients with NDCKD. (C) 2014 Medical University of Bialystok. Published by Elsevier Urban & Partner Sp. z o.o. All rights reserved.