Feng-Yi Hsu1, Fang-Ju Lin1,2,3, Huang-Tz Ou4, Shih-Hui Huang5, Chi-Chuan Wang1,3. 1. School of Pharmacy, Taipei, Taiwan. 2. Graduate Institute of Clinical Pharmacy, College of Medicine, Taipei, Taiwan. 3. Department of Pharmacy, National Taiwan University Hospital, Taipei, Taiwan. 4. Institute of Clinical Pharmacy and Pharmaceutical Sciences, National Cheng Kung University, Tainan, Taiwan. 5. Internal Medicine, Penghu Hospital, Department of Health, The Executive Yua, Penghu, Taiwan.
Abstract
BACKGROUND/AIMS: Limited evidence exists on the choice of angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin II receptor blockers (ARBs) in diabetic patients with nephropathy. We aim to assess the renal effectiveness and safety of these drugs among diabetic nephropathy patients. METHODS: This retrospective cohort study was conducted with diabetic nephropathy patients who initiated ACEI or ARB monotherapy. The primary outcome was a composite of end stage of renal disease and renal transplantation, and the secondary outcome was all-cause mortality. The safety endpoint was hyperkalemia. RESULTS: Three thousand seven hundred and thirty-nine ACEI users and 3,316 ARB users were identified. ARBs seemed to be inferior to ACEIs given their poorer renal outcome (HR 1.31; 95% CI, 1.15-1.50) and higher risk of hyperkalemia (HR 1.17; 95% CI, 1.04-1.32). Among the four ACEIs compared, captopril was an inferior treatment choice given its poorer renal outcomes (HR 1.42; 95% CI, 1.05-1.93) and higher mortality rate (HR 1.25; 95% CI, 1.01-1.55). Irbesartan appeared to be a poorer treatment choice among the three ARBs compared, given its inferior renal protective effect (HR 1.35; 95% CI, 1.03-1.78). CONCLUSIONS: Our findings suggest ACEIs as a relatively more renoprotective and safer treatment as compared to ARBs. Captopril and irbesartan may be inferior to the other ACEIs and ARBs respectively.
BACKGROUND/AIMS: Limited evidence exists on the choice of angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin II receptor blockers (ARBs) in diabeticpatients with nephropathy. We aim to assess the renal effectiveness and safety of these drugs among diabetic nephropathypatients. METHODS: This retrospective cohort study was conducted with diabetic nephropathypatients who initiated ACEI or ARB monotherapy. The primary outcome was a composite of end stage of renal disease and renal transplantation, and the secondary outcome was all-cause mortality. The safety endpoint was hyperkalemia. RESULTS: Three thousand seven hundred and thirty-nine ACEI users and 3,316 ARB users were identified. ARBs seemed to be inferior to ACEIs given their poorer renal outcome (HR 1.31; 95% CI, 1.15-1.50) and higher risk of hyperkalemia (HR 1.17; 95% CI, 1.04-1.32). Among the four ACEIs compared, captopril was an inferior treatment choice given its poorer renal outcomes (HR 1.42; 95% CI, 1.05-1.93) and higher mortality rate (HR 1.25; 95% CI, 1.01-1.55). Irbesartan appeared to be a poorer treatment choice among the three ARBs compared, given its inferior renal protective effect (HR 1.35; 95% CI, 1.03-1.78). CONCLUSIONS: Our findings suggest ACEIs as a relatively more renoprotective and safer treatment as compared to ARBs. Captopril and irbesartan may be inferior to the other ACEIs and ARBs respectively.
Authors: Ivan Krečak; Martina Morić Perić; Ivan Zekanović; Hrvoje Holik; Božena Coha; Velka Gverić-Krečak; Marko Lucijanić Journal: Wien Klin Wochenschr Date: 2021-02-08 Impact factor: 1.704
Authors: Randa I Farah; Mohammed Q Al-Sabbagh; Munther S Momani; Asma Albtoosh; Majd Arabiat; Ahmad M Abdulraheem; Husam Aljabiri; Mohammad Abufaraj Journal: BMC Nephrol Date: 2021-06-16 Impact factor: 2.388