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. 2011;6(1):26-31.
doi: 10.2185/jrm.6.26.

Successful treatment of hypertension in anuric hemodialysis patients with a direct Renin inhibitor, aliskiren

Yoshitaka Maeda  1 , Yuya Araki  1 , Tomomi Uno  1 , Keisuke Nishigaki  1 , Naoto Inaba  1
Affiliations

Successful treatment of hypertension in anuric hemodialysis patients with a direct Renin inhibitor, aliskiren

Yoshitaka Maeda et al. J Rural Med. 2011.

Abstract

Objective: A direct renin-inhibitor (DRI), aliskiren, was administered to anuric patients to investigate whether it can be a new optional therapy against hypertension in hemodialysis (HD) patients.

Patients: The patients that received aliskiren comprised 8 males and 2 females with a mean ± SD age of 63 ± 8 years (43-72 years). They were exposed to dialysis therapy for 118 ± 73 months (8-251 months), with diabetes mellitus in 4 cases, chronic glomerulonephritis in 4 cases, and other diagnoses in 2 cases.

Methods: After the plasma renin activity (PRA) and plasma aldosterone concentration (PAC) were measured before an HD session, aliskiren, 150 mg as an initial dose, was administered to the patients. PRA and PAC were also examined a week after initiating aliskiren. The blood pressure (BP) levels at the start of each HD session for a period of 2 weeks (6 HD sessions) were compared between before and after administration of aliskiren. The change of doses in other antihypertensive agents was also counted.

Results: The averaged reduction of mean blood pressure was 4 ± 5 mmHg, and doses of antihypertensives other than aliskiren were reduced in 4 patients. Of the examined parameters, only the reduction rate of PRA x PAC seemed correlated with the BP lowering effect of aliskiren, which was calculated as the sum of the mean BP reduction in mmHg and drug reduction with 1 tablet (capsule)/day considered to be 10 mmHg.

Conclusion: A DRI, aliskiren, was effective even in anuric dialysis patients, and monitoring of PRA and PAC was valuable for selecting cases responsive to aliskiren.

Keywords: antihypertensive drugs; prorenin; vascular RAS.

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Figures

Figure 1
Figure 1
Effect of aliskiren on BP. Systolic, mean, and diastolic BP were averaged for before and after administration of aliskiren for 2 weeks (6 measurements before HD sessions). *: p < 0.05. **: p < 0.01.
Figure 2
Figure 2
Changes of serum K, PRA and PAC after administration of aliskiren. Only PRA was significantly reduced. PAC was rather elevated in 2 patients.
Figure 3
Figure 3
PRA, PAC before treatment and prorenin after treatment and their correlation with the score for the BP lowering effect. These values were not significantly correlated. The correlation coefficients of the score and PRA, PAC and prorenin were 0.06, 0.21 and 0.08, respectively.
Figure 4
Figure 4
Reduction rate of (PRA × PAC) and the score for the BP lowering effect. These values were not significantly correlated (Y = 0.12X – 0.78, r = 0.44, p = 0.20), but high BP lowering effects (score > 5) were observed only in the cases showing a high percent reduction rate (> 80%).
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