Incidence and factors associated with prescribing renin-angiotensin-system inhibitors in adult idiopathic nephrotic syndrome: A nationwide cohort study.

Autor: Nishiwaki H; Division of Nephrology, Department of Internal Medicine, Showa University Fujigaoka Hospital, Yokohama, Japan.; Showa University Research Administration Center (SURAC), Showa University, Shinagawa, Tokyo, Japan., Niihata K; Department of Clinical Epidemiology, Graduate School of Medicine, Fukushima Medical University, Fukushima, Japan., Shimizu S; Institute for Health Outcomes & Process Evaluation Research (iHope International), Kyoto, Japan.; Section of Clinical Epidemiology, Department of Community Medicine, Kyoto University, Kyoto, Japan., Shibagaki Y; Department of Nephrology and Hypertension, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan., Yamamoto R; Health and Counseling Center, Osaka University, Toyonaka, Japan., Nitta K; Department of Medicine, Kidney Center, Tokyo Women's Medical University, Shinjuku, Tokyo, Japan., Tsukamoto T; Division of Nephrology and Dialysis, Kitano Hospital, Tazuke Kofukai Medical Research Institute, Osaka, Japan., Uchida S; Department of Internal Medicine, Teikyo University School of Medicine, Itabashi, Tokyo, Japan., Takeda A; Kidney Disease Center, Japanese Red Cross Nagoya Daini Hospital, Nagoya, Japan., Okada H; Department of Nephrology, Saitama Medical University, Moroyama Town, Saitama, Japan., Narita I; Division of Clinical Nephrology and Rheumatology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan., Isaka Y; Department of Nephrology, Osaka University Graduate School of Medicine, Suita, Japan., Kurita N; Department of Clinical Epidemiology, Graduate School of Medicine, Fukushima Medical University, Fukushima, Japan.; Department of Innovative Research and Education for Clinicians and Trainees (DiRECT), Fukushima Medical University Hospital, Fukushima, Japan.
Jazyk: angličtina
Zdroj: Journal of clinical hypertension (Greenwich, Conn.) [J Clin Hypertens (Greenwich)] 2021 May; Vol. 23 (5), pp. 999-1007. Date of Electronic Publication: 2021 Mar 01.
DOI: 10.1111/jch.14224
Abstrakt: Angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) are prescribed as conservative or adjunctive therapies for adult idiopathic nephrotic syndrome. However, studies on real-world practice patterns are scarce. This study aimed to examine the prevalence and incidence of ACEI/ARB prescription and their associated factors. This nationwide cohort study included adult Japanese patients with idiopathic nephrotic syndrome including minimal change disease (MCD), membranous nephropathy (MN), focal segmental glomerulosclerosis (FSGS), and others. The outcomes were the prevalence of ACEI/ARB prescription at baseline (date of renal biopsy or date of immunosuppressant initiation) and at 2 months after baseline. Of the 326 eligible patients, 122 (37.4%) had already been prescribed ACEIs/ARBs. Of the remaining 204 patients, 67 (32.7%) were newly prescribed within the 2-month period. MN/FSGS (vs. MCD, adjusted odds ratio [AOR]: 4.96 [95% confidence interval {CI} 2.53-9.72] and 3.95 [95% CI 1.61-9.66], respectively), higher age (per 1-yr increase, AOR: 1.02 [95% CI 1.00-1.04]), other hypertensive agents (AOR: 2.18 [95% CI 1.21-3.92]), antidiabetic drug (AOR: 6.57 [95% CI 1.77-24.4]) were associated with a higher prevalence of ACEI/ARB prescription. MN (vs. MCD, AOR: 6.00 [95% CI 2.57-14.0]) and higher baseline systolic blood pressure (SBP) (per 10-mmHg increase, AOR: 1.36 [95% CI 1.09-1.70]) were associated with a higher incidence of ACEI/ARB prescription. On average, incidence of ACEI/ARB prescription increased from 19.2% to 40.8% as baseline SBP increased from 100 to 140 mmHg. Thus, Japanese nephrologists are likely to prescribe ACEIs/ARBs for nephrotic patients with MN or high baseline SBP, even below the hypertensive range.
(© 2021 The Authors. The Journal of Clinical Hypertension published by Wiley Periodicals LLC.)
Databáze: MEDLINE
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