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.