Key result
ACEI therapy showed no significant difference compared to ARB therapy for the risk of long-term dialysis in patients with diabetes (HR 0.93, 95% CI 0.83-1.03).
Why the study?
Do angiotensin-converting enzyme inhibitors (ACEIs) improve major renal outcomes compared to angiotensin II receptor blockers (ARBs) in adults with diabetes?
Cohort (n=57,815)
Do angiotensin-converting enzyme inhibitors (ACEIs) improve major renal outcomes compared to angiotensin II receptor blockers (ARBs) in adults with diabetes?
ACEIs and ARBs have similar overall effects on major renal outcomes in patients with diabetes, but ACEIs may offer superior renoprotection in those with comorbid cardiovascular or chronic kidney disease.
Answers are grounded in this paper and cite their sources.
ACEIs and ARBs show comparable dialysis risk in diabetes overall; leaves open potential subgroup benefits in CVD or CKD.
BACKGROUND: Angiotensin converting enzyme inhibitors (ACEIs) and angiotensin II receptor blockers (ARBs) are considered to have similar renoprotective effects; so far there has been no consensus about their priorities. This study aimed to compare ACEIs and ARBs for major renal outcomes and survival in a 15-year cohort of adults with diabetes. METHODS: This study utilized Taiwan's medical and pharmacy claims data in the Longitudinal Cohort of Diabetes Patients. The primary outcome was long-term dialysis, and secondary outcomes were hospitalization for acute kidney injury, hospitalization for hyperkalemia, all-cause death, cardiovascular death, and non-cardiovascular death. Cox proportional hazards models were used to estimate the hazard ratios (HRs) and 95% confidence intervals (CIs) for outcomes comparing ACEIs with ARBs. We conducted subgroup analyses and interaction tests among patients with different age and comorbid diseases. RESULTS: A total of 34,043 patients received ACEIs and 23,772 patients received ARBs. No differences were found for primary or secondary outcomes in the main analyses. ACEIs showed significantly lower hazard than ARBs for long-term dialysis among patients with cardiovascular disease (HR 0.80, 95% CI 0.66-0.97, interaction P = 0.003) or chronic kidney disease (0.81, 0.71-0.93, interaction P = 0.001). CONCLUSIONS: Our analyses show similar effects of ACEIs and ARBs in patients with diabetes. However, ACEIs might provide additional renoprotective effects among patients who have cardiovascular disease or chronic kidney disease.
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Wu et al. (2017) conducted a cohort in Diabetes (n=57,815). Angiotensin-converting enzyme inhibitors (ACEIs) vs. Angiotensin II receptor blockers (ARBs) was evaluated on Long-term dialysis (HR 0.93, 95% CI 0.83-1.03). ACEI therapy showed no significant difference compared to ARB therapy for the risk of long-term dialysis in patients with diabetes (HR 0.93, 95% CI 0.83-1.03).
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