Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • News & Views
  • Published:

Hypertension

RAS blockade, hyperkalemia and AKI—look and you will find

Aliskiren combined with other inhibitors of the renin–angiotensin system increases the risk of hyperkalemia. This risk does not translate into an increased incidence of acute kidney injury, suggest the results of a meta-analysis. However, further research is needed to fully evaluate the safety of combination therapy with aliskiren.

This is a preview of subscription content, access via your institution

Access options

Buy this article

Prices may be subject to local taxes which are calculated during checkout

References

  1. US Food and Drug Administration. FDA approves new drug treatment for high blood pressure [online], (2007).

  2. Harel, Z. et al. The effect of combination treatment with aliskiren and blockers of the renin-angiotensin system on hyperkalaemia and acute kidney injury: systematic review and meta-analysis. BMJ 344, e42 (2012).

    Article  Google Scholar 

  3. Gormley, K., Dong, Y. & Sagnella, G. A. Regulation of the epithelial sodium channel by accessory proteins. Biochem. J. 371, 1–14 (2003).

    Article  CAS  Google Scholar 

  4. Toto, R. D., Mitchell, H. C., Lee, H. C., Milam, C. & Pettinger, W. A. Reversible renal insufficiency due to angiotensin converting enzyme inhibitors in hypertensive nephrosclerosis. Ann. Intern. Med. 115, 513–519 (1991).

    Article  CAS  Google Scholar 

  5. Mann, J. F. et al. for the TRANSCEND (Telmisartan Randomised Assessment Study in ACE Intolerant Subjects with Cardiovascular Disease) Investigators. Effect of telmisartan on renal outcomes: a randomized trial. Ann. Intern. Med. 151, 1–10 (2009).

    Article  Google Scholar 

  6. Ting, R. Z., Luk, A. O. & Chan, J. C. Treatment and landmark clinical trials for renoprotection. Contrib. Nephrol. 170, 184–195 (2011).

    Article  CAS  Google Scholar 

  7. Mehdi, U. F., Adams-Huet, B., Raskin, P., Vega, G. L. & Toto, R. D. Addition of angiotensin receptor blockade or mineralocorticoid antagonism to maximal angiotensin-converting enzyme inhibition in diabetic nephropathy. J. Am. Soc. Nephrol. 20, 2641–2650 (2009).

    Article  CAS  Google Scholar 

  8. Juurlink, D. N. et al. Rates of hyperkalemia after publication of the Randomized Aldactone Evaluation Study. N. Engl. J. Med. 351, 543–551 (2004).

    Article  CAS  Google Scholar 

  9. Oparil, S. et al. Efficacy and safety of combined use of aliskiren and valsartan in patients with hypertension: a randomised, double-blind trial. Lancet 370, 221–229 (2007).

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Ethics declarations

Competing interests

R. D. Toto is a consultant for and has received research funding from Novartis.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Toto, R. RAS blockade, hyperkalemia and AKI—look and you will find. Nat Rev Nephrol 8, 257–258 (2012). https://doi.org/10.1038/nrneph.2012.62

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/nrneph.2012.62

Search

Quick links

Nature Briefing: Translational Research

Sign up for the Nature Briefing: Translational Research newsletter — top stories in biotechnology, drug discovery and pharma.

Get what matters in translational research, free to your inbox weekly. Sign up for Nature Briefing: Translational Research