Effects of Aliskiren in Elderly Hypertensive Chronic Kidney Disease (CKD) Patients

Chronic kidney disease (CKD) was reported to be affecting 11% of the all population. This number is much higher in the elderly population and may be as high as 30%. CKD is an independent risk factor of cardiovascular disease (CVD). This is called "Cardio-renal Continuum". The renin-angiotensin-aldosterone system (RAS) plays pivotal roles in both cardiovascular and renal functions.

The increased oxidative stress by activated RAS on vascular endothelium is one of important factor to development of Cardio-renal Continuum. The blockade of RAS by angiotensin I converting enzyme inhibitors (ACEIs) and/or angiotensin receptor blockers (ARBs) has been reported to ameliorate the renal disease and CVD; however,they do not completely suppress RAS, leading to a reactive rise in plasma renin activity (PRA). Aliskiren, an oral direct renin inhibitor, is effective against essential hypertension by reducing PRA, resulting in more complete suppression of RAS; however, little is known about the effects of aliskiren on heart and kidney functions in elderly hypertensive CKD patients. In this study, we assessed the efficacy of aliskiren on heart and kidney functions in elderly hypertensive CKD patients.

Inclusion criteria

• Clinical diagnosis of Chronic kidney disease
• Clinical diagnosis of Hypertension (Blood pressure >=140/90mmHg)
• Elderly people(>=65 years old)

Exclusion criteria

• The patients who are already taking aliskiren
• The patients who are receiving hemodialysis or peritoneal dialysis
• The patients who are taking cyclosporin
• The patients who have hyperkalemia(>=5.5mEq/ml)
• Severe heart failure (>=NYHA class III)
• Insulin dependent diabetic mellitus or poor controlled insulin independent diabetic mellitus (>=HbA1c 9.0&)
• Severe liver dysfunction (five folds increased AST or ALT than standard values)