Key result
The use of renin-angiotensin system inhibitors to slow chronic kidney disease progression in elderly patients lacks supporting evidence, suggesting therapy goals should be individualized.
Why the study?
Do renin-angiotensin system inhibitors slow the progression of chronic kidney disease in elderly patients with diabetic nephropathy?
Do renin-angiotensin system inhibitors slow the progression of chronic kidney disease in elderly patients with diabetic nephropathy?
The routine use of RAS inhibitors to slow CKD progression in elderly patients with diabetic nephropathy lacks strong evidence and should be individualized.
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.
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Hiromichi Suzuki (2015) conducted an editorial in Chronic kidney disease and diabetic nephropathy. Renin-angiotensin system (RAS) inhibitors was evaluated. The use of renin-angiotensin system inhibitors to slow chronic kidney disease progression in elderly patients lacks supporting evidence, suggesting therapy goals should be individualized.
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