title: Effects of valsartan on progression of kidney disease in Japanese hypertensive patients with advanced, predialysis, chronic kidney disease: Kanagawa Valsartan Trial (KVT).
abstract: Suppression of the renin-angiotensin system is known to slow progression of chronic kidney disease (CKD). However, few trials have been performed with Japanese patients. This study investigated whether the angiotensin receptor blocker (ARB) valsartan would delay the progression of kidney disease more effectively than conventional treatment in Japanese hypertensive patients with advanced, predialysis CKD. In a multicenter, randomized, open-label trial, 303 patients with hypertension and CKD with serum creatinine levels 2.0 mg dl(-1) were assigned to receive either conventional therapy plus valsartan (valsartan add-on group) or conventional therapy without ARB (control group). The primary outcome was a change in serum creatinine levels. Changes in urinary protein levels and time to onset of renal events were analyzed as secondary end points. There were no between-group differences in blood pressure during the study. Changes in serum creatinine and urinary protein levels did not differ between the groups. However, the rate of renal events, including doubling of serum creatinine levels or end-stage renal disease, was significantly lower in the valsartan add-on group than in the control group. The addition of valsartan decreased the risk by 42.6% after adjustment for baseline variables. The addition of valsartan to conventional therapy significantly slowed the rate of renal function decline and delayed the need for renal replacement therapy in Japanese hypertensive patients with advanced CKD.
authors.affiliation: Department of Medicine, Division of Nephrology and Hypertension, St Marianna University School of Medicine, Kawasaki, Japan. yasuda@marianna-u.ac.jp
authors.forename: Takashi
authors.initials: T
authors.lastname: Yasuda
authors.forename: Masayuki
authors.initials: M
authors.lastname: Endoh
authors.forename: Daisuke
authors.initials: D
authors.lastname: Suzuki
authors.forename: Asio
authors.initials: A
authors.lastname: Yoshimura
authors.forename: Terukuni
authors.initials: T
authors.lastname: Ideura
authors.forename: Kozo
authors.initials: K
authors.lastname: Tamura
authors.forename: Kouju
authors.initials: K
authors.lastname: Kamata
authors.forename: Yoshiyuki
authors.initials: Y
authors.lastname: Toya
authors.forename: Satoshi
authors.initials: S
authors.lastname: Umemura
authors.forename: Kenjiro
authors.initials: K
authors.lastname: Kimura
mesh_terms: D000368:Aged; D047228:Angiotensin II Type 1 Receptor Blockers / Q000627:therapeutic use*; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D044466:Asian People; D001794:Blood Pressure / Q000502:physiology; D015897:Comorbidity; D003404:Creatinine / Q000097:blood; D018450:Disease Progression; D005260:Female; D006801:Humans; D006973:Hypertension / Q000188:drug therapy* / Q000453:epidemiology / Q000503:physiopathology; D007564:Japan; D008297:Male; D008875:Middle Aged; D011507:Proteinuria / Q000652:urine; D051436:Renal Insufficiency, Chronic / Q000188:drug therapy* / Q000453:epidemiology / Q000503:physiopathology; D017582:Renal Replacement Therapy; D013777:Tetrazoles / Q000627:therapeutic use*; D016896:Treatment Outcome; D014633:Valine / Q000031:analogs & derivatives* / Q000627:therapeutic use; D000068756:Valsartan
chemical_list: D047228:Angiotensin II Type 1 Receptor Blockers; D000959:Antihypertensive Agents; D013777:Tetrazoles; D000068756:Valsartan; D003404:Creatinine; D014633:Valine