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Article: Direct Renin Inhibition in Non-diabetic chronic Kidney disease (DRINK): a prospective randomized trial

TitleDirect Renin Inhibition in Non-diabetic chronic Kidney disease (DRINK): a prospective randomized trial
Authors
Keywordschronic renal disease
outcomes
renin inhibitor
Issue Date2020
PublisherOxford University Press. The Journal's web site is located at http://ndt.oxfordjournals.org/
Citation
Nephrology Dialysis Transplantation, 2020, Epub 2020-07-20, p. article no. gfaa085 How to Cite?
AbstractBackground: The potential long-term safety and efficacy of aliskiren in nondiabetic chronic kidney disease (CKD) are unknown. We sought to investigate the renoprotective effect of aliskiren on nondiabetic CKD patients. Methods: In this open-label, parallel, randomized controlled trial, nondiabetic CKD Stages 3–4 patients were randomized to receive aliskiren added to an angiotensin II receptor blocker (ARB) at the maximal tolerated dose, or ARB alone. Primary outcome was the rate of change in estimated glomerular filtration rate (eGFR). Secondary endpoints included rate of change in urine protein-to-creatinine ratio (UPCR), cardiovascular events and hyperkalemia. Composite renal outcomes of doubling of baseline serum creatinine or a 40% reduction in eGFR or incident end-stage renal disease or death were analyzed as post hoc analysis. Results: Seventy-six patients were randomized: 37 to aliskiren (mean age 55.1 ± 11.1 years) and 39 to control (mean age 55.0 ± 9.4 years). Their baseline demographics were comparable to eGFR (31.9 ± 9.0 versus 27.7 ± 9.0 mL/min/1.73 m2, P = 0.05) and UPCR (30.7 ± 12.6 versus 47.8 ± 2.8 mg/mmol, P = 0.33) for treatment versus control subjects. After 144 weeks of follow-up, there was no difference in the rate of eGFR change between groups. Six patients in the aliskiren group and seven in the control group reached the renal composite endpoint (16.2% versus 17.9%, P = 0.84). The cardiovascular event rate was 10.8% versus 2.6% (P = 0.217). The hyperkalemia rate was 18.9% versus 5.1% with an adjusted hazard ratio of 7.71 (95% confidence interval 1.14 to 52.3, P = 0.04) for the aliskiren arm. Conclusion: Aliskiren neither conferred additional renoprotective benefit nor increased adverse events, except for more hyperkalemia in nondiabetic CKD patients.
Persistent Identifierhttp://hdl.handle.net/10722/283982
ISSN
2019 Impact Factor: 4.531
2015 SCImago Journal Rankings: 1.780

 

DC FieldValueLanguage
dc.contributor.authorTang, SCW-
dc.contributor.authorChan, KW-
dc.contributor.authorIp, DKM-
dc.contributor.authorYap, DYH-
dc.contributor.authorMa, MKM-
dc.contributor.authorMok, MMY-
dc.contributor.authorChan, GCW-
dc.contributor.authorTam, S-
dc.contributor.authorLai, KN-
dc.date.accessioned2020-07-20T05:55:05Z-
dc.date.available2020-07-20T05:55:05Z-
dc.date.issued2020-
dc.identifier.citationNephrology Dialysis Transplantation, 2020, Epub 2020-07-20, p. article no. gfaa085-
dc.identifier.issn0931-0509-
dc.identifier.urihttp://hdl.handle.net/10722/283982-
dc.description.abstractBackground: The potential long-term safety and efficacy of aliskiren in nondiabetic chronic kidney disease (CKD) are unknown. We sought to investigate the renoprotective effect of aliskiren on nondiabetic CKD patients. Methods: In this open-label, parallel, randomized controlled trial, nondiabetic CKD Stages 3–4 patients were randomized to receive aliskiren added to an angiotensin II receptor blocker (ARB) at the maximal tolerated dose, or ARB alone. Primary outcome was the rate of change in estimated glomerular filtration rate (eGFR). Secondary endpoints included rate of change in urine protein-to-creatinine ratio (UPCR), cardiovascular events and hyperkalemia. Composite renal outcomes of doubling of baseline serum creatinine or a 40% reduction in eGFR or incident end-stage renal disease or death were analyzed as post hoc analysis. Results: Seventy-six patients were randomized: 37 to aliskiren (mean age 55.1 ± 11.1 years) and 39 to control (mean age 55.0 ± 9.4 years). Their baseline demographics were comparable to eGFR (31.9 ± 9.0 versus 27.7 ± 9.0 mL/min/1.73 m2, P = 0.05) and UPCR (30.7 ± 12.6 versus 47.8 ± 2.8 mg/mmol, P = 0.33) for treatment versus control subjects. After 144 weeks of follow-up, there was no difference in the rate of eGFR change between groups. Six patients in the aliskiren group and seven in the control group reached the renal composite endpoint (16.2% versus 17.9%, P = 0.84). The cardiovascular event rate was 10.8% versus 2.6% (P = 0.217). The hyperkalemia rate was 18.9% versus 5.1% with an adjusted hazard ratio of 7.71 (95% confidence interval 1.14 to 52.3, P = 0.04) for the aliskiren arm. Conclusion: Aliskiren neither conferred additional renoprotective benefit nor increased adverse events, except for more hyperkalemia in nondiabetic CKD patients.-
dc.languageeng-
dc.publisherOxford University Press. The Journal's web site is located at http://ndt.oxfordjournals.org/-
dc.relation.ispartofNephrology Dialysis Transplantation-
dc.subjectchronic renal disease-
dc.subjectoutcomes-
dc.subjectrenin inhibitor-
dc.titleDirect Renin Inhibition in Non-diabetic chronic Kidney disease (DRINK): a prospective randomized trial-
dc.typeArticle-
dc.identifier.emailTang, SCW: scwtang@hku.hk-
dc.identifier.emailChan, KW: chriskwc@hku.hk-
dc.identifier.emailIp, DKM: dkmip@hku.hk-
dc.identifier.emailYap, DYH: desmondy@hku.hk-
dc.identifier.emailMa, MKM: h9914584@graduate.hku.hk-
dc.identifier.emailMok, MMY: mmymok@hku.hk-
dc.identifier.emailChan, GCW: gcwchan1@hku.hk-
dc.identifier.emailTam, S: stam@hkucc.hku.hk-
dc.identifier.emailLai, KN: knlai@hku.hk-
dc.identifier.authorityTang, SCW=rp00480-
dc.identifier.authorityIp, DKM=rp00256-
dc.identifier.authorityYap, DYH=rp01607-
dc.identifier.authorityLai, KN=rp00324-
dc.description.naturelink_to_subscribed_fulltext-
dc.identifier.doi10.1093/ndt/gfaa085-
dc.identifier.hkuros310828-
dc.identifier.volumeEpub 2020-07-20-
dc.identifier.spagearticle no. gfaa085-
dc.identifier.epagearticle no. gfaa085-
dc.publisher.placeUnited Kingdom-

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