Journal of Renin-Angiotensin-Aldosterone System http://jra.sagepub.com/
Renin inhibition in patients with chronic kidney disease: Is it conclusively non-indicated? Pantelis A Sarafidis and George L Bakris Journal of Renin-Angiotensin-Aldosterone System 2014 15: 97 DOI: 10.1177/1470320313485895 The online version of this article can be found at: http://jra.sagepub.com/content/15/1/97
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>> Version of Record - Feb 13, 2014 What is This?
Downloaded from jra.sagepub.com at University of Waikato Library on July 4, 2014
485895 2014
JRA15110.1177/1470320313485895Journal of the Renin-Angiotensin-Aldosterone SystemSarafidis and Bakris
Letter to the Editor
Renin inhibition in patients with chronic kidney disease: Is it conclusively non-indicated?
Journal of the Renin-AngiotensinAldosterone System 2014, Vol. 15(1) 97–98 © The Author(s) 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav DOI: 10.1177/1470320313485895 jra.sagepub.com
Pantelis A Sarafidis1 and George L Bakris2 The recently published ALTITUDE study compared the effects of combination treatment of aliskiren on top of angiotensin-converting enzyme inhibitor (ACEI) or angiotensin receptor blocker (ARB) versus ACEI or ARB alone on cardiovascular and renal outcomes in 8561 patients with type 2 diabetes.1 From a renal standpoint, this study was based on the pilot AVOID trial, where the addition of aliskiren on the background treatment of losartan significantly reduced proteinuria compared with placebo in patients with type 2 diabetes, hypertension and macroalbuminuria.2 The premature termination of ALTITUDE at 69% of events due to renal complications, hyperkalaemia, and hypotension in the aliskiren group received a lot of attention and was considered as the end of the era of double renin–angiotensin– aldosterone system (RAAS) blockade. The decision to terminate the trial early was justified statistically since event rate differences were unlikely to demonstrate a benefit of aliskiren if continued, and the authors provide a reasonable interpretation of results based on adverse events outweighing any anticipated benefits. However, there are some interesting points that one can raise from the full report of the study. Following the inclusion criteria (macroalbuminuria, or estimated glomerular filtration rate (eGFR) 30–60 ml/min/1.73m2 and microalbuminuria, or eGFR 30–60 ml/min/1.73m2 and history of cardiovascular disease), the mean age of the population was 65 years, 42% had cardiovascular disease, 67% had eGFR
Renin inhibition in patients with chronic kidney disease: Is it conclusively non-indicated? Pantelis A Sarafidis and George L Bakris Journal of Renin-Angiotensin-Aldosterone System 2014 15: 97 DOI: 10.1177/1470320313485895 The online version of this article can be found at: http://jra.sagepub.com/content/15/1/97
Published by: http://www.sagepublications.com
On behalf of: Frequently Asked Questions
Additional services and information for Journal of Renin-Angiotensin-Aldosterone System can be found at: Email Alerts: http://jra.sagepub.com/cgi/alerts Subscriptions: http://jra.sagepub.com/subscriptions Reprints: http://www.sagepub.com/journalsReprints.nav Permissions: http://www.sagepub.com/journalsPermissions.nav
>> Version of Record - Feb 13, 2014 What is This?
Downloaded from jra.sagepub.com at University of Waikato Library on July 4, 2014
485895 2014
JRA15110.1177/1470320313485895Journal of the Renin-Angiotensin-Aldosterone SystemSarafidis and Bakris
Letter to the Editor
Renin inhibition in patients with chronic kidney disease: Is it conclusively non-indicated?
Journal of the Renin-AngiotensinAldosterone System 2014, Vol. 15(1) 97–98 © The Author(s) 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav DOI: 10.1177/1470320313485895 jra.sagepub.com
Pantelis A Sarafidis1 and George L Bakris2 The recently published ALTITUDE study compared the effects of combination treatment of aliskiren on top of angiotensin-converting enzyme inhibitor (ACEI) or angiotensin receptor blocker (ARB) versus ACEI or ARB alone on cardiovascular and renal outcomes in 8561 patients with type 2 diabetes.1 From a renal standpoint, this study was based on the pilot AVOID trial, where the addition of aliskiren on the background treatment of losartan significantly reduced proteinuria compared with placebo in patients with type 2 diabetes, hypertension and macroalbuminuria.2 The premature termination of ALTITUDE at 69% of events due to renal complications, hyperkalaemia, and hypotension in the aliskiren group received a lot of attention and was considered as the end of the era of double renin–angiotensin– aldosterone system (RAAS) blockade. The decision to terminate the trial early was justified statistically since event rate differences were unlikely to demonstrate a benefit of aliskiren if continued, and the authors provide a reasonable interpretation of results based on adverse events outweighing any anticipated benefits. However, there are some interesting points that one can raise from the full report of the study. Following the inclusion criteria (macroalbuminuria, or estimated glomerular filtration rate (eGFR) 30–60 ml/min/1.73m2 and microalbuminuria, or eGFR 30–60 ml/min/1.73m2 and history of cardiovascular disease), the mean age of the population was 65 years, 42% had cardiovascular disease, 67% had eGFR
