SynthesisJournal of clinical hypertension (Greenwich, Conn.)2026
Effects of Aliskiren Monotherapy on Chronic Kidney Disease: A Systematic Review and Meta-Analysis of Blood Pressure and Urinary Protein Excretion Outcomes.
Synthesis in Journal of clinical hypertension (Greenwich, Conn.), 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Aliskiren has been proposed as an alternative for renin-angiotensin system blockage in chronic kidney disease (CKD); however, its efficacy and safety remain uncertain. The objective of this study was to evaluate the antihypertensive and antiproteinuric effects of aliskiren monotherapy in patients with CKD and hypertension. PRISMA 2020 guidelines were adopted for this systematic review and meta-analysis (PROSPERO: CRD420251024983). Relevant studies published (January 2001-February 2026) were identified in PubMed and Web of Science that compared aliskiren monotherapy with placebo or other antihypertensives in adults with CKD. Random-effects models were used to assess changes in systolic blood pressure (SBP), diastolic blood pressure (DBP), and urinary protein excretion. Risk of bias was evaluated using the RoB 2 and ROBINS-I tools. Nine trials (eight for quantitative analysis) were included. Overall, aliskiren did not significantly reduce SBP (MD -2.91 mmHg; 95% CI -8.74 to 2.91; p = 0.33) or DBP (n = 300; MD -1.35 mmHg; 95% CI -4.72 to 2.02; p = 0.43). In subgroup analysis, short-term trials (<24 weeks) showed significant SBP reduction (MD -9.31 mmHg; 95% CI -17.72 to -0.89), whereas longer-term studies (≥24 weeks) did not. Five trials (n = 209) reported a 28% reduction in urinary protein excretion with aliskiren (log response ratio -0.33; 95% CI -0.57 to -0.09; p = 0.007). Aliskiren provides a transient decrease in blood pressure and sustained antiproteinuric effect in patients with CKD, although heterogeneous and estimation-dependent. It may be considered an option for individuals intolerant of ACE inhibitors or angiotensin receptor blockers, although evidence on long-term efficacy and safety remains limited.
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