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.