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

Autor: Hiroki Nishiwaki, Kakuya Niihata, Sayaka Shimizu, Yugo Shibagaki, Ryohei Yamamoto, Kosaku Nitta, Tatsuo Tsukamoto, Shunya Uchida, Asami Takeda, Hirokazu Okada, Ichiei Narita, Yoshitaka Isaka, Noriaki Kurita, Japan Nephrotic Syndrome Cohort Study group
Jazyk: angličtina
Rok vydání: 2021
Předmět:
Zdroj: The Journal of Clinical Hypertension, Vol 23, Iss 5, Pp 999-1007 (2021)
Druh dokumentu: article
ISSN: 1751-7176
1524-6175
DOI: 10.1111/jch.14224
Popis: Abstract 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.
Databáze: Directory of Open Access Journals
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