Successful Treatment of Hypertension in Anuric Hemodialysis Patients with a Direct Renin Inhibitor,Aliskiren

Objective: A direct renin-inhibitor (DRI), aliskiren, was administered toanuric patients to investigate whether it can be a new optional therapy againsthypertension in hemodialysis (HD) patients.Patients: The patients that received aliskiren comprised 8 males and 2females with a mean ± SD age of 63 ± 8 years (43-72 years). They were exposed to dialysistherapy for 118 ± 73 months (8-251 months), with diabetes mellitus in 4 cases, chronicglomerulonephritis in 4 cases, and other diagnoses in 2 cases.Methods: After the plasma renin activity (PRA) and plasma aldosteroneconcentration (PAC) were measured before an HD session, aliskiren, 150 mg as an initialdose, was administered to the patients. PRA and PAC were also examined a week afterinitiating aliskiren. The blood pressure (BP) levels at the start of each HD session for aperiod of 2 weeks (6 HD sessions) were compared between before and after administration ofaliskiren. The change of doses in other antihypertensive agents was also counted.Results: The averaged reduction of mean blood pressure was 4 ± 5 mmHg, anddoses of antihypertensives other than aliskiren were reduced in 4 patients. Of theexamined parameters, only the reduction rate of PRA x PAC seemed correlated with the BPlowering effect of aliskiren, which was calculated as the sum of the mean BP reduction inmmHg and drug reduction with 1 tablet (capsule)/day considered to be 10 mmHg.Conclusion: A DRI, aliskiren, was effective even in anuric dialysispatients, and monitoring of PRA and PAC was valuable for selecting cases responsive toaliskiren.