Few studies have examined how renin angiotensin system inhibitors (RASIs) delay dialysis initiation in patients with advanced chronic kidney disease (CKD). We conducted a retrospective survey by reviewing the medical records before dialysis initiation in such patients, to examine how RASIs contributed to the retardation of renal failure.Design and method:
We reviewed the records of 720 patients with advanced CKD for 60-month period before dialysis initiation between 1990 and 2015. Patients were classified based on the decade of dialysis initiation into the 1990 s, 2000 s, and 2010 s groups. The number and duration of antihypertensive medications prescribed were assessed. The rate of decline of renal function was evaluated by the slope of reciprocal serum creatinine levels (SRSC). Multiple regression analyses were conducted to evaluate factors contributing to renoprotection.Results:
The duration of RASI administration in the 2010 s group was 36.3 ± 21.1 months, which were longer (P < 0.01) than 7.6 ± 15.8 months in the 2000 s group and 4.2 ± 10.2 months in the 1990 s group. SRSC in the 2010 s group was 0.007 ± 0.004 dL/mg/month, which was lower (P < 0.05) than those (0.011 ± 0.007 and 0.016 ± 0.008 dL/mg/month) in the 2000 s and 1990 s groups, respectively, suggesting that the deterioration rate of renal function was the slowest in the 2010 s group. Although the rates of prescription of five lines of antihypertensive drugs increased continuously during 60 months, the rate of RASI prescription alone showed an initial rise with a peak at 36 months followed by a decline thereafter. Multivariate regression analyses identified age, diabetes, serum calcium and phosphate, calcium channel blockers and diuretics as independent predictors to SRSC. RASIs did not correlate with SRSC. The rate of RASI prescription correlated with serum potassium concentrations (P = 0.04, r = 0.55).Conclusions:
RASIs did not contribute to retard the progression of advanced CKD, suggesting the reluctance in using RASIs because of the risk of hyperkalemia. In real-life clinical practice, alternative treatment with calcium channel blockers or diuretics may be preferred for better blood pressure control and renal protection in patients with advanced CKD.