Murakami Tomoyuki, Iwamoto Tamio, Yasuda Gen, Taniguchi Michiko, Fujiwara Akira, Hirawa Nobuhito, Umemura Satoshi
Division of Nephrology and Hypertension, Saiseikai Yokohamashi Nanbu Hospital, 3-2-10, Kounandai, kounan, Yokohama, 234-0054, Kanagawa, Japan.
Division of Nephrology and Hypertension, Yokohama City University, Yokohama, Japan.
Clin Exp Nephrol. 2016 Aug;20(4):603-610. doi: 10.1007/s10157-015-1191-2. Epub 2015 Oct 30.
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.
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.
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.
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.
很少有研究探讨肾素 - 血管紧张素系统抑制剂（RASI）如何延缓晚期慢性肾脏病（CKD）患者开始透析的时间。我们进行了一项回顾性调查来研究这个问题。
我们回顾了1990年至2015年期间开始透析前60个月的晚期CKD患者的记录。根据开始透析的年代将患者分为20世纪90年代、21世纪00年代和21世纪10年代组。评估所使用的抗高血压药物的比例。通过血清肌酐倒数（SRSC）的斜率评估肾功能下降的速率。进行多元回归分析以评估对肾脏保护有贡献的因素。
21世纪10年代RASI的使用时间比21世纪00年代和20世纪90年代更长。与21世纪00年代相比，21世纪10年代的糖尿病和非糖尿病患者的SRSC均较低。在21世纪10年代，透析前60个月期间RASI的使用比例呈先上升后下降的趋势，而其他类别的抗高血压药物的使用比例持续增加。多变量回归分析确定年龄、血压、利尿剂、α受体阻滞剂、α - 甲基多巴和RASI是21世纪10年代SRSC的独立预测因素。RASI的使用比例与血清钾浓度相关。
我们的研究结果表明，在21世纪10年代，RASI与其他抗高血压药物对晚期CKD患者的肾脏保护有贡献，但由于对高钾血症的担忧，它们未得到充分利用。在实际临床实践中，医生在晚期CKD患者中使用RASI时可能会非常犹豫。
