Direct Renin Inhibition in Non-diabetic chronic Kidney disease (DRINK): A prospective randomized trial

Sydney C. W. Tang*, Kam Wa Chan, Dennis K. M. Ip, Desmond Y. H. Yap, Maggie K. M. Ma, Maggie M. Y. Mok, Gary C. W. Chan, Sidney Tam, Kar Neng Lai

*Corresponding author for this work

Research output: Contribution to journalJournal articlepeer-review

6 Citations (Scopus)


Background: The potential long-term safety and efficacy of aliskiren in nondiabetic chronic kidney disease (CKD) are unknown. We sought to investigate the renoprotective effect of aliskiren on nondiabetic CKD patients. 

Methods: In this open-label, parallel, randomized controlled trial, nondiabetic CKD Stages 3-4 patients were randomized to receive aliskiren added to an angiotensin II receptor blocker (ARB) at the maximal tolerated dose, or ARB alone. Primary outcome was the rate of change in estimated glomerular filtration rate (eGFR). Secondary endpoints included rate of change in urine protein-to-creatinine ratio (UPCR), cardiovascular events and hyperkalemia. Composite renal outcomes of doubling of baseline serum creatinine or a 40% reduction in eGFR or incident end-stage renal disease or death were analyzed as post hoc analysis. 

Results: Seventy-six patients were randomized: 37 to aliskiren (mean age 55.1 ± 11.1 years) and 39 to control (mean age 55.0 ± 9.4 years). Their baseline demographics were comparable to eGFR (31.9 ± 9.0 versus 27.7 ± 9.0 mL/min/1.73 m2, P = 0.05) and UPCR (30.7 ± 12.6 versus 47.8 ± 2.8 mg/mmol, P = 0.33) for treatment versus control subjects. After 144 weeks of follow-up, there was no difference in the rate of eGFR change between groups. Six patients in the aliskiren group and seven in the control group reached the renal composite endpoint (16.2% versus 17.9%, P = 0.84). The cardiovascular event rate was 10.8% versus 2.6% (P = 0.217). The hyperkalemia rate was 18.9% versus 5.1% with an adjusted hazard ratio of 7.71 (95% confidence interval 1.14 to 52.3, P = 0.04) for the aliskiren arm. 

Conclusion: Aliskiren neither conferred additional renoprotective benefit nor increased adverse events, except for more hyperkalemia in nondiabetic CKD patients.

Original languageEnglish
Pages (from-to)1648-1656
Number of pages9
JournalNephrology Dialysis Transplantation
Issue number9
Publication statusPublished - 1 Sept 2021

Scopus Subject Areas

  • Medicine(all)
  • Nephrology
  • Epidemiology

User-Defined Keywords

  • chronic renal disease
  • outcomes
  • renin inhibitor


Dive into the research topics of 'Direct Renin Inhibition in Non-diabetic chronic Kidney disease (DRINK): A prospective randomized trial'. Together they form a unique fingerprint.

Cite this