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Supplementary data to the study of ESRD Map in Japan.

To the Editor: Our recent study [1] has added more convincing evidence for renoprotection of angiotensinconverting enzyme inhibitors (ACEIs) by asking whether the use of ACEIs may explain our previously disclosed important findings [i.e., regional variations in incidence of end-stage renal disease (ESRD)] in Japan [2]. In this study, we used the amounts of expense spent on ACEIs as an explanation. This was, however, a surrogate marker for a real use of ACEIs. Therefore, we next retrieved data regarding the real use of ACEIs from Nephro-Database in one large nephrology care center in Japan (Kimitsu Hospital) [3]. The rationale for using this database was that the hospital was the only nephrology center in its catchment area, excluding patients and hospital-based bias, and, more importantly, that the age-, sexand underlying disease-adjusted cumulative incidence of ESRD was significantly higher than other areas in Japan, for example, in 1997, 178.9 per 1 million in the area, and 127.1 in Japan as a whole, allowing us to compare ACEIs with other potential risk factors in the area where progression of renal failure was far accelerated. We conducted a retrospective chart review of 74 consecutive patients who had started renal replacement therapy (RRT) between January 1993 and December 2000. Multiple logistic regression