title: Role of renin-angiotensin system inhibitors in retardation of progression of end-stage renal failure: a retrospective study.
abstract: BACKGROUND
  Few studies have examined how renin-angiotensin system inhibitors (RASI) delay dialysis initiation in patients with advanced chronic kidney disease (CKD). We conducted a retrospective survey to examine this subject.
  
  
  METHODS
  We reviewed the records of patients with advanced CKD for the 60-month period before dialysis initiation between 1990 and 2015. Patients were classified based on the decade of dialysis initiation into the 1990s, 2000s, and 2010s groups. The rates of antihypertensive medications administered were assessed. The rate of decline of renal function was evaluated by the slope of reciprocal serum creatinine (SRSC). Multiple regression analyses were conducted to evaluate factors contributing to renoprotection.
  
  
  RESULTS
  The duration of RASI administration was longer in the 2010s than in 2000s and 1990s. Both diabetic and non-diabetic patients had lower SRSC in the 2010s compared to the 2000s. In the 2010s, the rate of RASI administration during the 60-month pre-dialysis period showed an initial rise followed by a downward trend, although the rates of administration of the other classes of antihypertensives increased continuously. Multivariate regression analyses identified age, blood pressure, diuretics, α-blockers, α-methyldopa and RASI as independent predictors of SRSC in the 2010s. The rate of RASI administration correlated with serum potassium concentration.
  
  
  CONCLUSIONS
  Our findings suggest that in the 2010s, RASI with other antihypertensive agents contributed to renoprotection in advanced CKD patients, but they were underused because of the concern over hyperkalemia. In real-world clinical practice, physicians may feel great hesitation in using RASI in patients with advanced CKD.
authors.affiliation: Division of Nephrology and Hypertension, Saiseikai Yokohamashi Nanbu Hospital, 3-2-10, Kounandai, kounan, Yokohama, 234-0054, Kanagawa, Japan. muraka_ni@yahoo.co.jp.
authors.forename: Tomoyuki
authors.initials: T
authors.lastname: Murakami
authors.affiliation: Division of Nephrology and Hypertension, Saiseikai Yokohamashi Nanbu Hospital, 3-2-10, Kounandai, kounan, Yokohama, 234-0054, Kanagawa, Japan.
authors.forename: Tamio
authors.initials: T
authors.lastname: Iwamoto
authors.affiliation: Division of Nephrology and Hypertension, Yokohama City University, Yokohama, Japan.
authors.forename: Gen
authors.initials: G
authors.lastname: Yasuda
authors.affiliation: Division of Nephrology and Hypertension, Saiseikai Yokohamashi Nanbu Hospital, 3-2-10, Kounandai, kounan, Yokohama, 234-0054, Kanagawa, Japan.
authors.forename: Michiko
authors.initials: M
authors.lastname: Taniguchi
authors.affiliation: Department of Medical Science and Cardiorenal Medicine, Yokohama City University, Yokohama, Japan.
authors.forename: Akira
authors.initials: A
authors.lastname: Fujiwara
authors.affiliation: Division of Nephrology and Hypertension, Yokohama City University, Yokohama, Japan.
authors.forename: Nobuhito
authors.initials: N
authors.lastname: Hirawa
authors.affiliation: Department of Medical Science and Cardiorenal Medicine, Yokohama City University, Yokohama, Japan.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Umemura
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000959:Antihypertensive Agents / Q000494:pharmacology / Q000627:therapeutic use*; D003404:Creatinine / Q000097:blood; D003928:Diabetic Nephropathies / Q000097:blood; D018450:Disease Progression; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000097:blood / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D011188:Potassium / Q000097:blood; D012044:Regression Analysis; D012084:Renin-Angiotensin System / Q000187:drug effects*; D012189:Retrospective Studies; D055815:Young Adult
chemical_list: D000959:Antihypertensive Agents; D003404:Creatinine; D011188:Potassium
keywords: End-stage renal failure; Renin–angiotensin system inhibitors