Efficacy and Safety of Complete RAAS Blockade with ALISKIREN in Patients with Refractory Proteinuria Who were already on Combined ACE Inhibitor, ARB, and Aldosterone Antagonist
Introduction: Proteinuria is always associated with intrinsic kidney disese and is a strong predictor of later development of End Stage Renal Disease (ESRD). As Renin Angiotensin Aldosterone System (RAAS) has a role in mediating proteinuria, inhibitors of this system are renoprotective and patie...
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doaj-b10c612bf687487ba3835bbb1a7ac0e52020-11-25T03:40:19ZengJCDR Research and Publications Private LimitedJournal of Clinical and Diagnostic Research2249-782X0973-709X2016-09-01109FC01FC0310.7860/JCDR/2016/20137.8414Efficacy and Safety of Complete RAAS Blockade with ALISKIREN in Patients with Refractory Proteinuria Who were already on Combined ACE Inhibitor, ARB, and Aldosterone AntagonistPrabitha Panattil0M Sreelatha1Assistant Professor, Department of Pharmacology, Government Medical College, Kottayam, Kerela, India.Professor and Head of Department, Department of Nephrology, Government Medical College, Calicut, Kerela, India.Introduction: Proteinuria is always associated with intrinsic kidney disese and is a strong predictor of later development of End Stage Renal Disease (ESRD). As Renin Angiotensin Aldosterone System (RAAS) has a role in mediating proteinuria, inhibitors of this system are renoprotective and patients with refractory proteinuria are put on a combination of these agents. The routinely employed triple blockade of RAAS with Angiotensin Converting Enzyme (ACE) inhibitor, ARB and Aldosterone antagonist has many limitations. Addition of Aliskiren to this combination suppresses the RAAS at the earliest stage and can offset many of these limitations. Aim: This study was conducted to assess the safety and efficacy of complete RAAS blockade by the addition of Aliskiren in those patients with refractory proteinuria who were already on triple blockade with ACE inhibitor, ARB and Aldosterone antagonist. Settings: This study was conducted in Nephrology Department, Calicut Medical College. Materials and Methods: A total of 36 patients with refractory proteinuria who were already on ACE inhibitor, ARB and Aldosterone antagonist were divided in to two groups A and B. Group A received Aliskiren in addition to the above combination whereas group B continued the same treatment for 12 weeks. Efficacy of the treatment was assessed by recording 24hr urine protein and safety by S.Creatinine, S.Potassium every 2 weeks of the treatment period. Statistical Analysis: Statistical analysis of the lab values was done using SPSS software. Unpaired t-test, Paired t-test and Chi-square test were done for data analysis. Results: Statistical analysis revealed that addition of Aliskiren to the combination therapy with ACE inhibitor+ ARB+ Aldosterone antagonist offers no advantage. But mean reduction in proteinuria was more with Group A than Group B. There is no statistically significant change in S.Creatinine and S.Potassium at the end of treatment. Conclusion: As proteinuria is a strong risk factor for progression to ESRD, even a mild decrease in proteinuria by treatment is renoprotective. Hence treatment with group A may be considered clinically superior to group B with no alteration in safety and tolerability. But further multicentre studies with larger sample size and dose escalation are required for confirmation.https://jcdr.net/articles/PDF/8414/20137_CE(RA1)_F(T)_PF1(AHAK)_PFA(AK)_PF2(PAG).pdfdirect renin inhibitorend stage renal diseasenephrotic syndrome |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Prabitha Panattil M Sreelatha |
spellingShingle |
Prabitha Panattil M Sreelatha Efficacy and Safety of Complete RAAS Blockade with ALISKIREN in Patients with Refractory Proteinuria Who were already on Combined ACE Inhibitor, ARB, and Aldosterone Antagonist Journal of Clinical and Diagnostic Research direct renin inhibitor end stage renal disease nephrotic syndrome |
author_facet |
Prabitha Panattil M Sreelatha |
author_sort |
Prabitha Panattil |
title |
Efficacy and Safety of Complete RAAS Blockade with ALISKIREN in Patients with Refractory Proteinuria Who were already on Combined ACE Inhibitor, ARB, and Aldosterone Antagonist |
title_short |
Efficacy and Safety of Complete RAAS Blockade with ALISKIREN in Patients with Refractory Proteinuria Who were already on Combined ACE Inhibitor, ARB, and Aldosterone Antagonist |
title_full |
Efficacy and Safety of Complete RAAS Blockade with ALISKIREN in Patients with Refractory Proteinuria Who were already on Combined ACE Inhibitor, ARB, and Aldosterone Antagonist |
title_fullStr |
Efficacy and Safety of Complete RAAS Blockade with ALISKIREN in Patients with Refractory Proteinuria Who were already on Combined ACE Inhibitor, ARB, and Aldosterone Antagonist |
title_full_unstemmed |
Efficacy and Safety of Complete RAAS Blockade with ALISKIREN in Patients with Refractory Proteinuria Who were already on Combined ACE Inhibitor, ARB, and Aldosterone Antagonist |
title_sort |
efficacy and safety of complete raas blockade with aliskiren in patients with refractory proteinuria who were already on combined ace inhibitor, arb, and aldosterone antagonist |
publisher |
JCDR Research and Publications Private Limited |
series |
Journal of Clinical and Diagnostic Research |
issn |
2249-782X 0973-709X |
publishDate |
2016-09-01 |
description |
Introduction: Proteinuria is always associated with intrinsic
kidney disese and is a strong predictor of later development
of End Stage Renal Disease (ESRD). As Renin Angiotensin
Aldosterone System (RAAS) has a role in mediating proteinuria,
inhibitors of this system are renoprotective and patients with
refractory proteinuria are put on a combination of these agents.
The routinely employed triple blockade of RAAS with Angiotensin
Converting Enzyme (ACE) inhibitor, ARB and Aldosterone
antagonist has many limitations. Addition of Aliskiren to this
combination suppresses the RAAS at the earliest stage and can
offset many of these limitations.
Aim: This study was conducted to assess the safety and efficacy
of complete RAAS blockade by the addition of Aliskiren in those
patients with refractory proteinuria who were already on triple
blockade with ACE inhibitor, ARB and Aldosterone antagonist.
Settings: This study was conducted in Nephrology Department,
Calicut Medical College.
Materials and Methods: A total of 36 patients with refractory
proteinuria who were already on ACE inhibitor, ARB and
Aldosterone antagonist were divided in to two groups A and B.
Group A received Aliskiren in addition to the above combination
whereas group B continued the same treatment for 12 weeks.
Efficacy of the treatment was assessed by recording 24hr urine
protein and safety by S.Creatinine, S.Potassium every 2 weeks
of the treatment period.
Statistical Analysis: Statistical analysis of the lab values was
done using SPSS software. Unpaired t-test, Paired t-test and
Chi-square test were done for data analysis.
Results: Statistical analysis revealed that addition of Aliskiren to
the combination therapy with ACE inhibitor+ ARB+ Aldosterone
antagonist offers no advantage. But mean reduction in
proteinuria was more with Group A than Group B. There is no
statistically significant change in S.Creatinine and S.Potassium
at the end of treatment.
Conclusion: As proteinuria is a strong risk factor for progression to ESRD, even a mild decrease in proteinuria by treatment
is renoprotective. Hence treatment with group A may be
considered clinically superior to group B with no alteration in
safety and tolerability. But further multicentre studies with larger
sample size and dose escalation are required for confirmation. |
topic |
direct renin inhibitor end stage renal disease nephrotic syndrome |
url |
https://jcdr.net/articles/PDF/8414/20137_CE(RA1)_F(T)_PF1(AHAK)_PFA(AK)_PF2(PAG).pdf |
work_keys_str_mv |
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