Background : There have not been any informations available of whether diuretics may enhance renoprotective effects of ACEI and ARB. Methods Post-hoc analysis of the results of COOPERATE trial, asking the renoprotective effect of the combination therapy of ACEI and ARB (W-6-4, the 43 Annual Meeting of the JSN). 263 patients had been enrolled. To reduce their baseline blood pressure well below 130/80mmHg, diuretics and other agents including calcium channel blockers (CCB), a i - blocker (AB), Ĉ blocker (BB), other types of antihypertensives (OA) had been administered. Findings : As baseline antihypertensives, 91.6% of patients took CCBs, 62.1% did diuretics (mostly furosemide), 58.2%AB, 57.9%BB, and 45.6 OA. Compared with non-diuretic users, the diuretic users showed more potent reduction in dairy proteinuria excretion, natriuresis, and blood neurohormonal values, such as renin, angiotensins, aldosterone, catecholamines, h-anp, and BANP. Interestingly, antiproteinuric effect with diuretic users had dose dependency. Kaplan-Meier analysis revealed the significantly better renal survival with the diuretics- user (p = 0.039). There were no benefits observed in other type of antihypertensives between user and non-users. Interpretation This retrospective study clearly demonstrates the benefits of co usage of diuretics on ACEIs and/or ARBs, implying that diuretics be necessity of optimal renoprotective effects of them. These results, however, must be cautiously interpreted because of the design of this study, Post hoc analysis.

BACKGROUND : There have not been any information of whether renoprotection on ACEI and ARB, confirmed in a setting of randomized clinical trials, is also observed and for better management in dairy clinical practices. METH- ODS : In Kimitsu Hospital, a tertiary kidney disease-care center from a catchment area of the middle part of Chiba Prefecture, since Jan. 1997 intensive treatment project on ACEI and ARB(Kimitsu Angiotension-inhibitioin Project KAP) has been undertaken. This intervension consisted of 1) dominant usage of these agents despite of underlying etiology and baseline blood pressure and renal function 2) up-titration of their dosage as much as possible, and 3) discontinuation of other antihypertensives to avoid hypotension. Correction of acidosis, anemia, hyperphosphatemia, and repeated diet-education were also performed. Primary object was a change in an annual incidence of patients requiring hemodialyis per the total number of renal disease patients between Jan. 1992 and DEC. 2001. FINDINGS : From 1999 the annual incidence of RRP was clearly reduced from 10.6% (in 1992) to 5.9% (in 2001). To know the reason (- s) for this improvement, a cohort of 289 patients was analyzed before and after the RAP intervention. Blood pressure, blood and urinary chemical parameters, and quality of life were significantly improved after the intervention. This advantage of the intervention was observed after adjusting of other renoprotective interventions. INTERPRETAION : The renoprotection of ACEI and ARB is also observed in a setting of clinical practice.