Effects of valsartan on progression of kidney disease in Japanese hypertensive patients with advanced, predialysis, chronic kidney disease: Kanagawa Valsartan Trial (KVT)

摘要

The number of patients developing end-stage renal disease (ESRD) has increased continuously over the past 10 years in Japan. Most of these patients have a progressive decline of renal function over many years before renal replacement therapy (RRT) is required. In numerous Western studies, blockade of the renin-angiotensin system (RAS) with either angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin II type 1 receptor blockers (ARBs) has been shown to delay the progression of disease in patients with chronic kidney disease (CKD). Based on these studies, many guidelines, including those from Japan, strongly recommend the use of ACEIs or ARBs in hypertensive patients with CKD. However, few trials have examined the effects of a RAS inhibitor on the progression of kidney disease in Japanese patients with hypertension and advanced, predialysis CKD. Given that Japanese and Western patients may have different responses to therapeutic agents, clinical data from other countries are not necessarily applicable to Japanese patients. Understanding the measures to prevent disease progression is an important goal for Japanese CKD patients. Among RAS inhibitors, ARBs are preferred in Japan because ACEIs cause a dry cough in a high proportion of the Asian population. Therefore, the aim of the present study was to examine the add-on effects of one of the ARBs, valsartan, on the course of renal disease progression in Japanese patients with hypertension and advanced CKD.