Maps of end-stage renal disease and amounts of angiotensin-converting enzyme inhibitors prescribed in Japan.
BACKGROUND
We recently found regional differences in the incidence of end-stage renal disease (ESRD) in Japan, which is generally ethnically homogeneous, suggesting that factors other than genetic may contribute to the difference. Here, we examined regional differences in the amounts of expenses spent on antihypertensives, especially angiotensin-converting enzyme (ACE) inhibitors, in our search for an explanation.


METHODS
Annually, the Japanese Society for Dialysis Therapy reports the numbers of patients entering maintenance dialysis in each prefecture of Japan since 1982. We used the findings for 1995 to 2000 to calculate the annual incidence of ESRD in each of the 11 regions of Japan. In addition, regional differences in annual amounts paid for antihypertensive drugs, presumably corresponding to the amounts used, during the same 6 years, corrected for population, were estimated.


RESULTS
As in our 1982 to 1998 study, the incidence of ESRD was high in Okinawa, Kyushu, and Shikoku, while low in Hokuriku, Koshinetsu, and Tohoku (P < 0.0001) [one-way repeated measures analysis of variance (ANOVA)]. We found regional differences in the corrected sum paid for total antihypertensive drugs, ACE inhibitors and calcium antagonists. Only ACE inhibitors were negatively correlated with the incidence of ESRD by linear and multiple regression analyses.


CONCLUSIONS
The renal protective effects of ACE inhibitors have been established by results with animal models of progressive nephropathy and large-scale clinical trials. Our epidemiologic results for Japan as a whole show the same protective effects still more convincingly from a different approach.
Usami
Takeshi
T
Department of Internal Medicine and Pathophysiology, Nagoya City University Graduate School of Medical Sciences,Mizuho-ku, Nagoya, Japan. t-usami@med.nagoya-cu.ac.jp
Nakao
Naoyuki
N
Fukuda
Michio
M
Takeuchi
Oki
O
Kamiya
Yoshinobu
Y
Yoshida
Atsuhiro
A
Kimura
Genjiro
G
D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use*; D003710:Demography; D011307:Drug Prescriptions / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D007564:Japan; D007676:Kidney Failure, Chronic / Q000188:drug therapy* / Q000453:epidemiology*; D012044:Regression Analysis
D000806:Angiotensin-Converting Enzyme Inhibitors