Comparative effectiveness of angiotensinconverting enzyme inhibitors versus angiotensin II receptor blockers for major renal outcomes in patients with diabetes: A 15-year cohort study
Journal
PLoS ONE
Journal Volume
12
Journal Issue
5
Pages
e0177654
Date Issued
2017
Author(s)
Wu H.-Y.
Peng C.-L.
Chen P.-C.
Chang C.-J.
Peng Y.-S.
Abstract
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. ? 2017 Wu et al.This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
SDGs
Other Subjects
angiotensin receptor antagonist; dipeptidyl carboxypeptidase inhibitor; angiotensin receptor antagonist; dipeptidyl carboxypeptidase inhibitor; acute kidney failure; adult; age; aged; Article; cardiovascular mortality; chronic kidney failure; cohort analysis; comorbidity; comparative effectiveness; death; diabetes mellitus; dialysis; drug efficacy; female; hospitalization; human; hyperkalemia; long term care; longitudinal study; major clinical study; male; outcome assessment; renal protection; survival; Taiwan; diabetes mellitus; Diabetic Nephropathies; drug effects; epidemiology; health survey; Kaplan Meier method; kidney; metabolism; middle aged; mortality; multimodality cancer therapy; proportional hazards model; Renal Insufficiency, Chronic; treatment outcome; very elderly; Adult; Aged; Aged, 80 and over; Angiotensin Receptor Antagonists; Angiotensin-Converting Enzyme Inhibitors; Cohort Studies; Combined Modality Therapy; Comorbidity; Diabetes Mellitus; Diabetic Nephropathies; Female; Humans; Kaplan-Meier Estimate; Kidney; Male; Middle Aged; Population Surveillance; Proportional Hazards Models; Renal Insufficiency, Chronic; Taiwan; Treatment Outcome
Publisher
Public Library of Science
Type
journal article