Abstract: TH-PO0324
Renin-Angiotensin System Inhibitors Are Not Associated with Reduced Cardiovascular Risk in Nonproteinuric CKD: Post Hoc Analysis of the FROM-J Study
Session Information
- Hypertension and CVD: Clinical - 1
November 06, 2025 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Hypertension and CVD
- 1602 Hypertension and CVD: Clinical
Authors
- Sugawara, Hirohito, Division of Nephrology, Department of Internal Medicine, Showa Medical University Northern Yokohama Hospital, Yokohama, Japan
- Yoshida, Kiryu, Division of Nephrology, Department of Internal Medicine, Showa Medical University Northern Yokohama Hospital, Yokohama, Japan
- Saito, Chie, Department of Nephrology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
- Kato, Akihiko, Department of Nephrology, Kosai Municipal Hospital, Kosai, Japan
- Narita, Ichiei, Division of Clinical Nephrology and Rheumatology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
- Maruyama, Shoichi, Department of Nephrology, Nagoya University Graduate School of Medicine, Nagoya, Japan
- Wada, Jun, Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences,, Okayama, Japan
- Wada, Takashi, Department of Nephrology and Rheumatology, Kanazawa University, Kanazawa, Japan
- Ito, Hidetoshi, Division of Nephrology, Department of Internal Medicine, Showa Medical University Northern Yokohama Hospital, Yokohama, Japan
- Yamagata, Kunihiro, Department of Nephrology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
- Ogata, Hiroaki, Division of Nephrology, Department of Internal Medicine, Showa Medical University Northern Yokohama Hospital, Yokohama, Japan
Background
Cardiovascular events (CVEs) are highly prevalent among individuals with chronic kidney disease (CKD). Current clinical guidelines recommend the use of renin–angiotensin system inhibitors (RASi) to provide cardiovascular protection in those with proteinuric CKD. However, it remains unclear whether RASi are effective in preventing cardiovascular disease (CVD) in individuals with non-proteinuric CKD. In this study, we assessed the effects of RASi on cardiovascular morbidity and mortality in individuals with non-proteinuric CKD.
Methods
The cohort included patients without proteinuria at study entry from the prospective FROM-J study. Non-proteinuric CKD was defined as urine protein <0.15 g/d or a result of negative or trace protein on urinalysis (i.e., less than 1+). We assessed the relationship between RASi use and cardiovascular morbidity and mortality using Cox proportional hazards regression. The primary outcome was a composite of CVEs or initiation of renal replacement therapy or all-cause mortality.
Results
Of the 2,379 patients with CKD, 630 met the inclusion criteria. At baseline, 490 individuals were using RASi, while 140 were not. The RASi group was younger (66.6 vs. 68.8 years, P < 0.01); however, sex distribution (69.2% men vs. 70.7%), diabetes prevalence (50.6% vs. 47.8%), and eGFR (44.7 ± 11.1 vs. 46.0 ± 11.1 mL/min/1.73 m2) were comparable. In the RASi group, the proportion of patients with a history of hypertension (96.3% vs. 73.9%, P < 0.01), blood pressure (systolic: 134 ± 13 vs. 130 ± 12 mmHg, P < 0.01; diastolic: 77 ± 10 vs. 75 ± 9 mmHg, P < 0.01), and those taking calcium channel blockers (69.6% vs. 44.3%, P < 0.01) were higher. Compared with the control group, no significant association was found between RASi use and either CVEs or cardiovascular death (adjusted HR 1.37 for CVEs; 95% CI, 0.81–2.31). The composite outcome was also similar between individuals who used RASi during the observation period and those who did not (adjusted HR 0.81; 95% CI, 0.43–1.56).
Conclusion
In this study, the use of RASi was not associated with incident CVEs in individuals with non-proteinuric CKD.
Funding
- Government Support – Non-U.S.