THERAPEUTIC ROLE OF ALISKIREN MONOTHERAPY IN CHRONIC KIDNEY DISEASE: A SYSTEMATIC REVIEW AND META-ANALYSIS OF ANTIHYPERTENSIVE AND ANTIPROTEINURIC EFFECTS
Author(s)
N M Mahmudul Alam Bhuiya, M Pharm;
Clinical and Administrative Pharmacy, College of Pharmacy, University of Georgia, PhD Student, Athens, GA, USA
Clinical and Administrative Pharmacy, College of Pharmacy, University of Georgia, PhD Student, Athens, GA, USA
OBJECTIVES: Aliskiren has been proposed as an alternative renin-angiotensin system (RAS) blocker for patients with chronic kidney disease (CKD) who are unable to tolerate ACE inhibitors or angiotensin receptor blockers. However, its comparative clinical value remains uncertain. This study evaluated the antihypertensive and antiproteinuric effectiveness of aliskiren monotherapy in adults with CKD.
METHODS: This systematic review and meta-analysis followed PRISMA 2020 guidelines (PROSPERO: CRD420251024983). Searches were conducted in PubMed, Web of Science, and ClinicalTrials.gov (January 2001-March 2025). Eligible studies included clinical trials comparing aliskiren monotherapy with placebo or active comparators in adults with CKD. Random-effects models estimated mean differences (MDs) for systolic/diastolic blood pressure and log response ratios for urinary protein excretion. Risk of bias was assessed using RoB 2 and ROBINS-I, and subgroup analyses evaluated treatment duration and diabetes comorbidity.
RESULTS: Eight studies were included (n=300 for blood pressure outcomes; n=209 for proteinuria). Aliskiren did not significantly reduce systolic blood pressure (SBP) (MD −2.91 mmHg; 95% CI −8.74 to 2.91) or diastolic blood pressure (MD −1.35 mmHg; 95% CI −4.72 to 2.02). Short-term trials (<24 weeks) demonstrated significant SBP reduction (MD −9.31 mmHg; 95% CI −17.72 to −0.89), whereas long-term studies (≥24 weeks) did not show significant differences. Aliskiren produced a significant 28% reduction in urinary protein excretion (log response ratio −0.33; 95% CI −0.57 to −0.09). Effects were consistent across diabetic and non-diabetic subgroups.
CONCLUSIONS: Aliskiren monotherapy provides a short-term reduction in blood pressure and a sustained antiproteinuric effect in adults with CKD. While it may serve as an alternative for patients intolerant to ACEIs/ARBs, long-term evidence on its clinical and economic value remains limited. Additional comparative studies are needed to clarify its role in CKD management and quantify its potential impact for payers and health systems.
METHODS: This systematic review and meta-analysis followed PRISMA 2020 guidelines (PROSPERO: CRD420251024983). Searches were conducted in PubMed, Web of Science, and ClinicalTrials.gov (January 2001-March 2025). Eligible studies included clinical trials comparing aliskiren monotherapy with placebo or active comparators in adults with CKD. Random-effects models estimated mean differences (MDs) for systolic/diastolic blood pressure and log response ratios for urinary protein excretion. Risk of bias was assessed using RoB 2 and ROBINS-I, and subgroup analyses evaluated treatment duration and diabetes comorbidity.
RESULTS: Eight studies were included (n=300 for blood pressure outcomes; n=209 for proteinuria). Aliskiren did not significantly reduce systolic blood pressure (SBP) (MD −2.91 mmHg; 95% CI −8.74 to 2.91) or diastolic blood pressure (MD −1.35 mmHg; 95% CI −4.72 to 2.02). Short-term trials (<24 weeks) demonstrated significant SBP reduction (MD −9.31 mmHg; 95% CI −17.72 to −0.89), whereas long-term studies (≥24 weeks) did not show significant differences. Aliskiren produced a significant 28% reduction in urinary protein excretion (log response ratio −0.33; 95% CI −0.57 to −0.09). Effects were consistent across diabetic and non-diabetic subgroups.
CONCLUSIONS: Aliskiren monotherapy provides a short-term reduction in blood pressure and a sustained antiproteinuric effect in adults with CKD. While it may serve as an alternative for patients intolerant to ACEIs/ARBs, long-term evidence on its clinical and economic value remains limited. Additional comparative studies are needed to clarify its role in CKD management and quantify its potential impact for payers and health systems.
Conference/Value in Health Info
2026-05, ISPOR 2026, Philadelphia, PA, USA
Value in Health, Volume 29, Issue S6
Code
CO7
Topic
Clinical Outcomes
Topic Subcategory
Comparative Effectiveness or Efficacy
Disease
SDC: Cardiovascular Disorders (including MI, Stroke, Circulatory), SDC: Urinary/Kidney Disorders