Open AccessTime to re-evaluate effects of renin-angiotensin system inhibitors on renal and cardiovascular outcomes in diabetic nephropathy
Author(s) -
Hiromichi Suzuki,
Tomohiro Kikuta,
Tsutomu Inoue,
Ukihiro Hamada
Publication year - 2015
Publication title -
world journal of nephrology
Language(s) - English
Resource type - Journals
ISSN - 2220-6124
DOI - 10.5527/wjn.v4.i1.118
Subject(s) - medicine , diabetic nephropathy , kidney disease , disease , renin–angiotensin system , clinical trial , nephropathy , diabetes mellitus , kidney , intensive care medicine , endocrinology , blood pressure
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.