Key result
In diabetic patients with CKD, treatment with ARBs was associated with a greater mean decrease in hemoglobin levels compared to ACEIs (-0.43 vs -0.11 g/dl; P=0.025).
Why the study?
Do ARBs compared to ACEIs reduce hemoglobin levels in Japanese adults with type 2 diabetes and chronic kidney disease?
Cohort (n=201)
Do ARBs compared to ACEIs reduce hemoglobin levels in Japanese adults with type 2 diabetes and chronic kidney disease?
Treatment with ARBs, but not ACEIs, may be associated with a modest decrease in hemoglobin levels in diabetic patients with chronic kidney disease.
Answers are grounded in this paper and cite their sources.
May warrant hemoglobin monitoring with ARBs in diabetic CKD; hypothesis-generating for class-specific effects versus ACEIs.
BACKGROUND: Treatment with angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin-receptor blockers (ARBs) may be associated with reduced erythrocyte production in several clinical settings; however, these effects have not been determined in diabetic patients with chronic kidney disease (CKD), a high-risk population for anemia. We conducted a retrospective study to assess the effects of ACEIs and ARBs on hemoglobin levels in Japanese adults with type 2 diabetes and CKD. METHODS: Diabetic patients with an estimated glomerular filtration rate (eGFR) <60 ml/min/1.73 m(2), who filled a prescription for an ACEI or ARB, were included. Changes in hemoglobin levels after initiating treatment with an ACEI or ARB were compared using multivariate analysis of covariance (ANCOVA) and propensity-score matching to minimize the bias. RESULTS: A total of 201 diabetic patients, 77 treated with an ACEI and 124 treated with an ARB, fulfilled study criteria and constituted the retrospective cohort. Mean (+/-s.e.) change in hemoglobin (adjusted for covariates) was greater for patients treated with ARBs (-0.43 +/- 0.08 g/dl) than patients treated with ACEIs (-0.11 +/- 0.11 g/dl, P = 0.025) by ANCOVA. In the propensity-score cohort analysis of 57 pairs of ACEI/ARB-treated patients, a significant decrease in hemoglobin was observed in patients treated with an ARBs (-0.54 +/- 1.02 g/dl (mean +/- s.d.), P < 0.001), but not in patients treated with an ACEIs (-0.14 +/- 0.98 g/dl, P = 0.294). CONCLUSIONS: Treatment with an ARB, but not ACEI, may be associated with a modest decrease in hemoglobin levels in diabetic patients with CKD.
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Inoue et al. (2008) conducted a cohort in Type 2 diabetes and chronic kidney disease (n=201). Angiotensin-receptor blockers (ARBs) vs. Angiotensin-converting enzyme inhibitors (ACEIs) was evaluated on Change in hemoglobin levels (p=0.025). In diabetic patients with CKD, treatment with ARBs was associated with a greater mean decrease in hemoglobin levels compared to ACEIs (-0.43 vs -0.11 g/dl; P=0.025).
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