Risks Associated with Renin-angiotensin System Inhibitor Therapy in Elderly Patients with Nephrosclerosis

Background and Objectives: Studies have investigated the effect of antihypertensive treatment in patients with hypertensive nephrosclerosis. To our knowledge, there is no cohort study on the effect of antihypertensive treatment in elderly patients with nephrosclerosis. Therefore, our aim was to evaluate the efficacy and risks associated with the use of antihypertensive agents, especially renin-angiotensin system (RAS) inhibitors, in this population. Patients and Methods: This was a retrospective cohort study. Patients aged ≥65 years and diagnosed with nephrosclerosis who were treated in our department between August 2013 and October 2014 were included in this study and were observed for 12 consecutive months. Results: Forty-three patients were included in this study. Thirty-three patients were men, and 10 were women. The mean age of the subjects was 79.3 ± 7.1 years. At the start of this study, mean values of serum creatinine (Cr) and estimated glomerular filtration rate (eGFR) were 2.48 ± 1.32 mg/dL and 25.0 ± 12.8 mL/min/1.73 m 2 , respectively. At the end of the observation period, hemodialysis was initiated for 5 patients. The mean value of eGFR decreased by 12.2 ± 21.5%, and 3 patients had a decrease of more than 30% in eGFR. Cr values at the start correlated positively with the percentage of decrease in eGFR. Cr values at the start and RAS inhibitor usage rate were significantly associated with adverse effects, such as hyperkalemia and transient Cr elevation. Conclusion: Our study suggests that antihypertensive treatment with RAS inhibitors may cause adverse effects in elderly patients with nephrosclerosis. Caution should be exercised when administering RAS inhibitors to these patients.