Academic literature on the topic 'Angiotensin converting enzyme Angiotensin II Proteinuria. Kidneys'

碩士<br>國立臺灣大學<br>藥學研究所<br>104<br>Background: Diabetes mellitus (DM) is a metabolic disease with high blood sugar levels over extended periods. Angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin II receptor blockers (ARBs) are the first-line medications for patients with diabetic nephropathy. While there are many ACEIs and ARBs available on the market, the differences in renoprotective effectiveness and safety among various ACEI and ARB drugs are unclear. Objective: 1. To compare the renal effectiveness and safety of ACEIs and ARBs. 2. To individually assess the renal effectiveness and safety of different ACEI and ARB agents. 3. To analyze the effectiveness and safety of ACEIs and ARBs individually for patients aged 65 years and older. Methods: The present study used the Longitudinal Health Insurance Database (LHID) to conduct a retrospective cohort analyses. We selected the new users of the monotherapy of ACEI or ARB with the diagnosis of diabetic nephropathy from July 1, 2002 through December 31, 2013, and required patients to have a second prescription within 100 days following the first prescription. The primary outcome was composited of the ESRD and renal transplant. The secondary and safety outcome were defined as the death from any cause and the hyperkalemia event respectively. The analyses were conducted on an intention-to-treat (ITT) basis and an as-treated (AT) basis. Propensity score weighting was used to balance the numerous important baseline covariates. All analyses were conducted by using SAS 9.4 (SAS Institute Inc., Cary, NC, USA). Results and Discussion: In Aim 1, ARBs seem to be a poorer treatment choice for the diabetic nephropathy patients compared with ACEIs due to the inferior renal protective effect (hazard ratio[HR], 1.44; 95% confidence intervals [CI], 1.26-1.64; P<0.01) and poorer safety outcome (HR, 1.20; 95% CI, 1.05-1.36; P<0.01). In Aim 2, captopril and fosinopril seem to be poorer treatment choices among the 7 ACEI drugs due to the poorer renal outcome (captopril: HR, 1.41; 95% CI, 1.05-1.90; P=0.02 / fosinopril: HR, 1.56; 95% CI, 1.05-2.32; P=0.03) and the higher mortality rate (captopril: HR, 1.35; 95% CI, 1.11-1.65; P<0.01 / fosinopril: HR, 1.37; 95% CI, 1.03-1.81; P=0.03). Additionally, on account of the less renal benefit, irbesartan seems to be an inferior treatment choice among the 4 ARB drugs (HR, 1.38; 95% CI, 1.05-1.82; P=0.02). On the contrary, losartan may be the better treatment choice due to the greater reduction in the mortality (HR, 0.28; 95% CI, 0.09-0.84; P=0.02). In Aim 3, the elderly patients seem to be even less suitable to use ARBs than ACEIs than the overall study sample owing to the higher risk of renal outcomes (HR, 1.79; 95% CI, 1.42-2.27; P<0.01) and hyperkalemia (HR, 1.28; 95% CI, 1.07-1.54; P<0.01). In addition, taking mortality into account, captopril may be inferior to other 6 ACEI drugs for the older diabetic patients with proteinuria (HR, 3.07; 95% CI, 1.10-8.58; P=0.03). On the other hand, losartan may be superior to other 3 ARB drugs for this population due to a higher decrease in mortality (HR, 0.12; 95% CI, 0.02-0.93; P=0.04). Conclusions: Our findings support the use of ACEIs as a relatively renoprotective and safe treatment as compare to ARBs in the diabetic nephropathy patients, especially in the elderly population. Fosinopril and irbesartan seem to poorer treatment choice for the adult population among 7 ACEI drugs and 4 ARB drugs respectively. Both in the adult population and elderly patients, captopril may be inferior to other 6 ACEI drugs, and, conversely, losartan may be superior to other 3 ARB drugs.