Aliskiren Combined With Losartan in Proteinuric, Non-diabetic Chronic Kidney Disease

The University of Hong Kong (HKU)

Status and phase

Completed

Phase 4

Conditions

Kidney Disease

Treatments

Drug: Aliskiren

Drug: Losartan

Study type

Interventional

Funder types

Other

Identifiers

NCT01150201

Novartis-ST-02

Details and patient eligibility

About

Study objective: To investigate the potential anti-proteinuric and renoprotective efficacy of aliskiren in addition to losartan in patients at risk of developing end-stage renal disease (ESRD)

Methods: This will be a randomized, double-blind study in which proteinuric, non-diabetic patients with chronic kidney disease (CKD) will be assigned in a 1:1 ratio to one of the following treatment groups for 3 years:

Group A: Losartan (Control arm: conventional treatment)*
Group B: Aliskiren plus Losartan (Intervention arm)*
- With optional addition of other anti-hypertensive agents to achieve an optimal target blood pressure of <130/80 mmHg.

Full description

Aliskiren is a direct renin inhibitor that has been shown to reduce proteinuria and retard renal deterioration in type 2 diabetic patients with overt nephropathy. However, it is not known if these therapeutic effects can be extended to nondiabetic chronic renal disease. The current study aims to explore this research question by randomly assigning patients with various stages of chronic renal disease to receive either aliskiren on top of losartan, or continuation of losartan.

Enrollment

80 estimated patients

Sex

All

Ages

18 to 70 years old

Volunteers

No Healthy Volunteers

Inclusion criteria

Male or female 18 - 80 years of age
Presence of nondiabetic CKD stages 3 to 4 as defined by estimated glomerular filtration rate (eGFR by 4-variable MDRD equation) as follows:
- Stage 3: Moderate decrease in GFR 30-59 mL/min/1.73 sq.m
- Stage 4: Severe decrease in GFR 15-29 mL/min/1.73 sq.m
- CKD is defined as either kidney damage or GFR <60 mL/min/1.73 m2 for > 3 months with variations of less than 30% in the 3 months before screening
Early-morning urinary protein-to-creatinine ratio of >500 mg/g or 57 mg/mmol on at least 2 occasions four weeks apart
Patients who are willing to give written, informed consent

Exclusion criteria

eGFR < 15 or > 60 ml/min/1.73m2
Early-morning urinary protein-to-creatinine ratio of >5000 mg/g or 570 mg/mmol, or urinary protein-to-creatinine ratio of <500 mg/g or 57 mg/mmol
Serum K+ > 5.2 mmol/L
Presence of bilateral renal artery stenosis
Known allergy to losartan or aliskiren
Patients who are receiving angiotensin II receptor blocker / angiotensin converting enzyme inhibitor combination within 12 weeks of randomization
Concurrent treatment with corticosteroids, nonsteroidal antiinflammatory drugs, or immunosuppressive agent
Patients with connective tissue disease or obstructive uropathy
Patients with concomitant malignancy or any such conditions that will severely limit life expectancy
Female who are pregnant or intending to conceive
Female of child-bearing age who are unwilling to practice effective contraception
Patients who are unable to give informed consent
Patients simultaneously participating in another study or who have participated in another study within the last 30 days of entry into this study