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Objective: To examine the safety of using aliskiren combined with agents used to block the renin-angiotensin system., Design: Systematic review and meta-analysis of randomised controlled trials., Data Sources: Medline, Embase, the Cochrane Library, and two trial registries, published up to 7 May 2011., Study Selection: Published and unpublished randomised controlled trials that compared combined treatment using aliskiren and angiotensin converting enzyme inhibitors or angiotensin receptor blockers with monotherapy using these agents for at least four weeks and that provided numerical data on the adverse event outcomes of hyperkalaemia and acute kidney injury. A random effects model was used to calculate pooled risk ratios and 95% confidence intervals for these outcomes., Results: 10 randomised controlled studies (4814 participants) were included in the analysis. Combination therapy with aliskiren and angiotensin converting enzyme inhibitors or angiotensin receptor blockers significantly increased the risk of hyperkalaemia compared with monotherapy using angiotensin converting enzymes or angiotensin receptor blockers (relative risk 1.58, 95% confidence interval 1.24 to 2.02) or aliskiren alone (1.67, 1.01 to 2.79). The risk of acute kidney injury did not differ significantly between the combined therapy and monotherapy groups (1.14, 0.68 to 1.89)., Conclusion: Use of aliskerin in combination with angiotensin converting enzyme inhibitors or angiotensin receptor blockers is associated with an increased risk for hyperkalaemia. The combined use of these agents warrants careful monitoring of serum potassium levels.

The article focuses on the systematic review and meta-analysis of the effect of the combination therapy of aliskiren and angiotensin converting enzyme (ACE) inhibitors on the risk of hyperkalaemia and acute kidney injury. It says that the study includes all randomised controlled trials involving aliskiren with ACE inhibitors. It mentions that the results showed that combined used of aliskiren and ACE inhibitors or angiostensin receptor blockers can increase the risk of hyperkalaemia.