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<p>Patients with chronic kidney disease (CKD) frequently experience cardiovascular events, and as per current therapeutic guidelines, renin-angiotensin system inhibitors (RASi) can protect the cardiovascular system in those with proteinuric CKD. Effectiveness of RASi in treating non-proteinuric CKD is still unknown, yet. In order to evaluate the impact of RASi on cardiovascular morbidity and mortality in patients with non-proteinuric CKD, we performed a post-hoc analysis of the Frontier of Renal Outcome Modification-Japan study. A urine protein-to-creatinine ratio less than 0.15 g/g or negative/trace protein on urinalysis was considered as non-proteinuric CKD. Those who have undergone dialysis, kidney transplant recipients, and patients who refused to give their consent were excluded. A composite of cardiovascular events, initiation of renal replacement therapy, and all-cause mortality was studied as the primary outcome. Of 2379 patients with CKD, 630 met the criteria for non-proteinuric CKD. Among them, 490 used RASi, and 140 did not. Although the RASi group was considerably younger and had a higher prevalence of hypertension and calcium channel blocker use, baseline characteristics were comparable. 12.1% of the control group and 16.7% of the RASi group experienced the primary outcome during follow-up, with no significant difference (adjusted HR: 1.37; 95% CI: 0.81–2.31). Secondary outcomes and analyses of RASi use for the whole observation period did not show any significant differences (adjusted HR: 0.81; 95% CI: 0.43–1.56). These results imply that RASi was not linked to a decreased risk of mortality or long-term events in those with nonproteinuric CKD.</p><p></p>

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Renin-angiotensin system inhibitor use and cardio-renal outcomes in non-proteinuric chronic kidney disease: a post-hoc analysis of the Frontier of Renal Outcome Modification-Japan study

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  • 发表日期：

    2026年1月14日

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  • Hirohito Sugawara,
  • Kiryu Yoshida,
  • Chie Saito,
  • Yoshinori Saito,
  • Masanori Kato,
  • Akihiko Kato,
  • Ichiei Narita,
  • Shoichi Maruyama,
  • Jun Wada,
  • Takashi Wada,
  • Masahiro Yamamoto,
  • Hidetoshi Ito,
  • Kunihiro Yamagata,
  • Hiroaki Ogata

摘要

Patients with chronic kidney disease (CKD) frequently experience cardiovascular events, and as per current therapeutic guidelines, renin-angiotensin system inhibitors (RASi) can protect the cardiovascular system in those with proteinuric CKD. Effectiveness of RASi in treating non-proteinuric CKD is still unknown, yet. In order to evaluate the impact of RASi on cardiovascular morbidity and mortality in patients with non-proteinuric CKD, we performed a post-hoc analysis of the Frontier of Renal Outcome Modification-Japan study. A urine protein-to-creatinine ratio less than 0.15 g/g or negative/trace protein on urinalysis was considered as non-proteinuric CKD. Those who have undergone dialysis, kidney transplant recipients, and patients who refused to give their consent were excluded. A composite of cardiovascular events, initiation of renal replacement therapy, and all-cause mortality was studied as the primary outcome. Of 2379 patients with CKD, 630 met the criteria for non-proteinuric CKD. Among them, 490 used RASi, and 140 did not. Although the RASi group was considerably younger and had a higher prevalence of hypertension and calcium channel blocker use, baseline characteristics were comparable. 12.1% of the control group and 16.7% of the RASi group experienced the primary outcome during follow-up, with no significant difference (adjusted HR: 1.37; 95% CI: 0.81–2.31). Secondary outcomes and analyses of RASi use for the whole observation period did not show any significant differences (adjusted HR: 0.81; 95% CI: 0.43–1.56). These results imply that RASi was not linked to a decreased risk of mortality or long-term events in those with nonproteinuric CKD.