Sheila Bermejo1, Carles Oriol García2, Eva Rodríguez3, Clara Barrios3, Sol Otero4, Sergi Mojal5, Julio Pascual3, María José Soler6. 1. Servicio de Nefrología, Hospital del Mar, Barcelona, España; Servicio de Nefrología, Fundació Althaia, Manresa, Barcelona, España. 2. Servicio de Nefrología, Hospital del Mar, Barcelona, España. 3. Servicio de Nefrología, Hospital del Mar, Barcelona, España; Fundació IMIM, Hospital del Mar, Barcelona, España. 4. Servicio de Nefrología, Consorci Sanitari del Garraf, Vilanova i la Geltrú, Barcelona, España. 5. Fundació IMIM, Hospital del Mar, Barcelona, España. 6. Servicio de Nefrología, Hospital del Mar, Barcelona, España; Fundació IMIM, Hospital del Mar, Barcelona, España. Electronic address: msoler@parcdesalutmar.cat.
Abstract
BACKGROUND AND OBJECTIVES: Diabetic kidney disease is the leading cause of end-stage chronic kidney disease. The renin-angiotensin-aldosterone system (RAAS) blockade has been shown to slow the progression of diabetic kidney disease. Our objectives were: to study the percentage of patients with diabetic kidney disease treated with RAAS blockade, to determine its renal function, safety profile and assess whether its administration is associated with increased progression of CKD after 3 years of follow-up. MATERIALS AND METHODS: Retrospective study. 197 diabetic kidney disease patients were included and divided into three groups according to the treatment: patients who had never received RAAS blockade (non-RAAS blockade), patients who at some point had received RAAS blockade (inconstant-RAAS blockade) and patients who received RAAS blockade (constant-RAAS blockade). Clinical characteristics and analytical variables such as renal function, electrolytes, glycosylated haemoglobin and glomerular filtration rate according to chronic kidney disease -EPI and MDRD formulas were assessed. We also studied their clinical course (baseline, 1 and 3 years follow-up) in terms of treatment group, survival, risk factors and renal prognosis. RESULTS: Non-RAAS blockade patients had worse renal function and older age (p<0.05) at baseline compared to RAAS blockade patients. Patients who received RAAS blockade were not found to have greater toxicity or chronic kidney disease progression and no differences in renal prognosis were identified. Mortality was higher in non-RAAS blockade patients, older patients and patients with worse renal function (p<0.05). In the multivariate analysis, older age and worse renal function were risk factors for mortality. CONCLUSIONS: Treatment with RAAS blockade is more common in diabetic kidney disease patients with eGFR≥30ml/min/1.73m2. In our study, there were no differences in the evolution of renal function between the three groups. Older age and worse renal function were associated with higher mortality in patients who did not receive RAAS blockade.
BACKGROUND AND OBJECTIVES:Diabetic kidney disease is the leading cause of end-stage chronic kidney disease. The renin-angiotensin-aldosterone system (RAAS) blockade has been shown to slow the progression of diabetic kidney disease. Our objectives were: to study the percentage of patients with diabetic kidney disease treated with RAAS blockade, to determine its renal function, safety profile and assess whether its administration is associated with increased progression of CKD after 3 years of follow-up. MATERIALS AND METHODS: Retrospective study. 197 diabetic kidney diseasepatients were included and divided into three groups according to the treatment: patients who had never received RAAS blockade (non-RAAS blockade), patients who at some point had received RAAS blockade (inconstant-RAAS blockade) and patients who received RAAS blockade (constant-RAAS blockade). Clinical characteristics and analytical variables such as renal function, electrolytes, glycosylated haemoglobin and glomerular filtration rate according to chronic kidney disease -EPI and MDRD formulas were assessed. We also studied their clinical course (baseline, 1 and 3 years follow-up) in terms of treatment group, survival, risk factors and renal prognosis. RESULTS: Non-RAAS blockade patients had worse renal function and older age (p<0.05) at baseline compared to RAAS blockade patients. Patients who received RAAS blockade were not found to have greater toxicity or chronic kidney disease progression and no differences in renal prognosis were identified. Mortality was higher in non-RAAS blockade patients, older patients and patients with worse renal function (p<0.05). In the multivariate analysis, older age and worse renal function were risk factors for mortality. CONCLUSIONS: Treatment with RAAS blockade is more common in diabetic kidney diseasepatients with eGFR≥30ml/min/1.73m2. In our study, there were no differences in the evolution of renal function between the three groups. Older age and worse renal function were associated with higher mortality in patients who did not receive RAAS blockade.
Authors: Laura Jane Smyth; Marisa Cañadas-Garre; Ruaidhri C Cappa; Alexander P Maxwell; Amy Jayne McKnight Journal: BMJ Open Date: 2019-05-01 Impact factor: 2.692