Suzuki Hiromichi, Kikuta Tomohiro, Inoue Tsutomu, Hamada Ukihiro
Hiromichi Suzuki, Tomohiro Kikuta, Tsutomu Inoue, Ukihiro Hamada, Department of Nephrology and Community Health Science Center, Saitama Medical University, Saitama 350-0495, Japan.
World J Nephrol. 2015 Feb 6;4(1):118-26. doi: 10.5527/wjn.v4.i1.118.
The use of renin-angiotensin system (RAS) inhibitors, such angiotensin converting enzyme inhibitors/angiotensin-II receptor blockers, to slow progression of chronic kidney disease (CKD) in a large group dominated by elderly people in the real world is not supported by available evidence. Large-scale clinical trials had many faults, among them a lack of focus on the elderly. However, it would be difficult to conduct clinical trials of a similar scale in elderly CKD patients. Besides, progression of kidney disease is often slow in elderly persons, and the vast majority of older adults with CKD will die before reaching end stage renal disease. Moreover, since it is not clear that progression of kidney disease, and even of proteinuric diabetic nephropathy, is not inhibited through the use of RAS inhibitors, the most patient-centric goal of therapy for many elderly individuals should be individualized.
在现实世界中，以老年人为主的一大群体使用肾素 - 血管紧张素系统（RAS）抑制剂，如血管紧张素转换酶抑制剂/血管紧张素II受体阻滞剂来减缓慢性肾脏病（CKD）进展，现有证据并不支持这一做法。大规模临床试验存在诸多缺陷，其中之一就是缺乏对老年人的关注。然而，对老年CKD患者进行类似规模的临床试验会很困难。此外，老年人的肾病进展通常较为缓慢，绝大多数老年CKD患者在达到终末期肾病之前就会死亡。而且，由于尚不清楚使用RAS抑制剂是否能抑制肾病进展，甚至蛋白尿性糖尿病肾病的进展，对于许多老年个体而言，最以患者为中心的治疗目标应该是个体化。
