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Advancing understanding of treatment through clinical trials
Date:11/3/2012

Three late-breaking studies presented during the American Society of Nephrology's Annual Kidney Week provide new information on drugs being tested in patients with diabetes or kidney disease.

Hans-Henrik Parving, MD (University of Copenhagen, in Denmark) and his colleagues investigated whether the drug aliskiren might improve the prognosis of patients with type 2 diabetes who are at high risk for developing heart and kidney problems. The randomized double-blind ALTITUDE trial included 8561 individuals who received aliskiren (300 mg once daily) or placebo on top of a drug that blocks the renin-angiotensin-aldosterone system (RAAS), a complex hormone system that regulates blood pressure and fluid balance. (Drugs that target the RAAS have limited effectiveness in part due to feedback responses, such as compensatory increases in an enzyme called renin. Aliskiren is a direct renin inhibitor and may help overcome these shortcomings because it suppresses the reactive rise in renin activity stimulated by other RAAS blockers.) After an average follow-up of 32.9 months:

  • 17.9% of patients receiving aliskiren and 16.8% of those receiving placebo experienced a heart attack or stroke, developed kidney disease, or died of cardiovascular disease.
  • Stroke occurred in 3.4% of patients taking aliskiren, compared with 2.7% of patients taking placebo.
  • Patients taking aliskiren experienced significantly increased blood potassium levels and hypotension.

"The trial does not support administration of aliskiren on top of standard therapy with RAAS blockade in type 2 diabetic patients at high risk for cardiovascular and renal events, and may even be harmful," the authors concluded.

Another team led by Vicente Torres, MD, PhD (Mayo Clinic) tested the potential of a vasopressin V2 receptor antagonist (tolvaptan) to inhibit cyst growth and slow kidney function decline in patients with autosomal dominant polycystic kidney disease (ADPKD).
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Contact: Adrienne Lea
alea@asn-online.org
202-503-6560
American Society of Nephrology
Source:Eurekalert

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