Renoprotective effect of aliskiren monotherapy and aliskiren-pentoxifylline combination in hypertensive-diabetic type 2 patients with diabetic nephropathy

Background: Diabetic nephropathy (DN) is one of the most serious complications of diabetes mellitus. Excessive activity of renin-angiotensin system plays a vital role in initiation and progression of DN. In addition, many studies have shown that inflammation plays a significant role in DN development. Purpose: This study was performed to evaluate the renoprotective effect of aliskiren (direct renin inhibitor) monotherapy and combination of aliskiren plus pentoxifylline (xanthine derivative) in hypertensive-diabetic type 2 patients with DN among patients in Gaza Strip. Methods: Forty hypertensive-diabetic type 2 patients with microalbuminurea (20–200 μg/min or 30–300 mg/24 h) were selected from UNRWA and private clinics in Gaza Strip and divided into two groups. The first group (n= 20) was treated with aliskiren (150 mg/day), whereas the second group (n=20) was treated with aliskiren-pentoxifylline combination (150, 400 mg/day). All patients were followed-up for nine months by measuring serum creatinine level and urinary albumin excretion (UAE) rate before and at 3, 6 and 9 months of treatment. Results: The results showed a significant reduction (P 0.05) in UAE rate among patients who used aliskiren and aliskiren-pentoxifylline combination after 6 and 9 months of treatment, where the reduction in both groups was more pronounced at 9 months of treatment. Moreover, the results also showed a significant reduction (P 0.05) in serum creatinine level after 6 and 9 months of aliskiren -pentoxifylline combination treatment, whereas the decrease became significant (P 0.05) only after 9 months of aliskiren treatment. Conclusion: Aliskiren monotherapy and aliskiren-pentoxifylline combination improved kidney function among hypertensive-diabetic type 2 patients with DN, however, aliskiren-pentoxifylline combination had a better renoprotective effect.