Antiproteinuric Response to Add-on Aliskiren in Proteinuric Patients Treated With Dual Blockade of the Renin-Angiotensin System: A 12-Month Prospective Uncontrolled Study

Antiproteinuric Response to Add-on Aliskiren in Proteinuric Patients Treated With Dual Blockade of the Renin-Angiotensin System: A 12-Month Prospective Uncontrolled Study: "Renin-angiotensin system (RAS) inhibition is the cornerstone treatment in proteinuric chronic kidney disease (CKD), but multiple escape mechanisms prevent adequate suppression. Compared with either monotherapy, dual blockade with an angiotensin-converting enzyme (ACE) inhibitor and angiotensin receptor blocker (ARB) improves proteinuria reduction by just 20%-30% on average. Consequently, many patients are left with residual proteinuria, which is still an important risk factor for end-stage renal disease. Recently, a synergistic antialbuminuric effect was evidenced when the direct renin inhibitor aliskiren was added to ARB therapy in diabetic patients with CKD. Here, we evaluate add-on aliskiren in proteinuric patients treated with an ACE inhibitor and ARB. Outcomes were proteinuria reduction after 6 months (primary) and maintenance at month 12, as well as safety (secondary)."