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World J Nephrol. Feb 6, 2015; 4(1): 118-126
Published online Feb 6, 2015. doi: 10.5527/wjn.v4.i1.118
Time to re-evaluate effects of renin-angiotensin system inhibitors on renal and cardiovascular outcomes in diabetic nephropathy
Hiromichi Suzuki, Tomohiro Kikuta, Tsutomu Inoue, Ukihiro Hamada
Hiromichi Suzuki, Tomohiro Kikuta, Tsutomu Inoue, Ukihiro Hamada, Department of Nephrology and Community Health Science Center, Saitama Medical University, Saitama 350-0495, Japan
Author contributions: All authors contributed to this work.
Conflict-of-interest: The authors declare no conflict of interest in this study.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Hiromichi Suzuki, MD, PhD, Department of Nephrology and Community Health Science Center, Saitama Medical University, 38 Moroyama-machi, Iruma-gun, Saitama 350-0495, Japan. iromichi@saitama-med.ac.jp
Telephone: +81-49-2761620 Fax: +81-49-2957338
Received: September 18, 2014
Peer-review started: September 18, 2014
First decision: November 1, 2014
Revised: November 13, 2014
Accepted: December 3, 2014
Article in press: December 10, 2014
Published online: February 6, 2015
Processing time: 142 Days and 2.7 Hours
Abstract

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.

Keywords: Angiotensin converting enzyme inhibitors; Angiotensin receptor blockers; Dialysis; Chronic kidney disease

Core tip: The use of renin-angiotensin system (RAS) inhibitors, such angiotensin converting enzyme inhibitors/angiotensin-II receptor blockers, to slow progression of chronic kidney disease in a large group dominated by elderly people in the real world is not supported by available evidence. 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.