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Could renin inhibition be the next step forward in the treatment of diabetic kidney disease?

Abstract

The current standard-of-care is inadequate to stem the rising tide of kidney failure, cardiovascular disease, and death attributable to diabetic kidney disease (DKD). Improved treatment approaches for DKD are, therefore, urgently needed. In this Practice Point commentary, I discuss a randomized, placebo-controlled clinical trial performed by Parving et al., which evaluated the effects of a renin inhibitor, aliskiren, on albuminuria in patients with type 2 diabetes mellitus and macroalbuminuria. The investigators administered aliskiren combined with losartan, an angiotensin-receptor blocker that represents current standard-of-care treatment for DKD. The primary outcome measure of the study—a 20% reduction in the mean urinary albumin-to-creatinine ratio in aliskiren-treated participants as compared with the placebo group—was achieved after 6 months' treatment. Although aliskiren holds promise, large, long-term studies are necessary to confirm its safety and to demonstrate its beneficial effect on clinical end points before renin inhibition is embraced as the next step forward in the treatment of DKD.

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References

  1. 1

    KDOQI (2007) KDOQI clinical practice guidelines and clinical practice recommendations for diabetes and chronic kidney disease. Am J Kidney Dis 49 (Suppl 2): S1–S179

  2. 2

    Lewis EJ et al. (1993) The effect of angiotensin-converting-enzyme inhibition on diabetic nephropathy. N Engl J Med 329: 1456–1462

    CAS  Article  Google Scholar 

  3. 3

    Lewis EJ et al. (2001) Renoprotective effect of the angiotensin-receptor antagonist irbesartan in patients with nephropathy due to type 2 diabetes. N Engl J Med 345: 851–860

    CAS  Article  Google Scholar 

  4. 4

    Brenner BM et al. (2001) Effects of losartan on renal and cardiovascular outcomes in patients with type 2 diabetes and nephropathy. N Engl J Med 345: 861–869

    CAS  Article  Google Scholar 

  5. 5

    Collins AJ et al. (2008) Incidence and prevalence of ESRD and Patient Characteristics. In Excerpts from the United States Renal Data System 2007 Annual Data Report. Am J Kidney Dis 51 (Suppl 1): S81–S110

    Google Scholar 

  6. 6

    Ingelfinger JR (2008) Aliskiren and dual therapy in type 2 diabetes mellitus. N Engl J Med 358: 2503–2505

    CAS  Article  Google Scholar 

  7. 7

    Parving HH et al. (2008) Aliskiren combined with losartan in type 2 diabetes and nephropathy. N Engl J Med 358: 2433–2446

    CAS  Article  Google Scholar 

Download references

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The author has declared associations with the following companies: AstraZeneca (grant/research support); Eli Lily (consultant); Fibrinogen (consultant); and Novartis (grant/research support).

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Tuttle, K. Could renin inhibition be the next step forward in the treatment of diabetic kidney disease?. Nat Rev Endocrinol 5, 20–21 (2009). https://doi.org/10.1038/ncpendmet0983

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