Prevention of new-onset chronic kidney disease with renin–angiotensin system blockers in type 2 diabetes with preserved kidney function

Renin–angiotensin system (RAS) blockers, including angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs), are known to slow chronic kidney disease (CKD) progression in patients with established renal impairment. However, whether RAS blockade can prevent new-onset CKD in patients with type 2 diabetes and hypertension who maintain preserved kidney function remains unclear. We addressed this question in a multicenter retrospective cohort study. Beginning with 316,693 individuals with type 2 diabetes and newly diagnosed hypertension, we retained 3,316 ACEI/ARB users and 1,409 nonusers after generalized boosted model weighting to equalize baseline characteristics. Three renal endpoints were followed: a sustained eGFR below 60 mL/min/1.73 m2, incident albuminuria (urinary albumin-to-creatinine ratio of 30 mg/g or higher), and a composite of either. Associations between RAS blocker exposure and each endpoint were quantified using Cox proportional hazards regression, with competing-risk and time-dependent variants applied as confirmatory analyses. ACEI/ARB therapy was associated with a significantly lower risk of new-onset CKD (HR 0.72; 95% CI 0.60–0.86), with consistent findings after accounting for competing risks (HR 0.73; 95% CI 0.61–0.87) and time-dependent exposure (HR 0.81; 95% CI 0.68–0.96). These findings suggest that RAS blockade may confer early kidney protection in patients with type 2 diabetes and hypertension with preserved renal function.