Angiotensin Drug Combo Increases Risk of Renal Injury
A study by the Veterans Affairs Nephropathy in Diabetes found that the combined use of an angiotensin-converting enzyme (ACE) inhibitor and an angiotensin receptor blocker (ARB) was associated with an increased risk of hyperkalemia and acute kidney injury in patients with diabetic nephropathy in a randomized, controlled trial.
ARB and ACE Study Results
- The study involved 1,448 patients with type 2 diabetes and moderate diabetic nephropathy; they were treated for at least 30 days with 100 mg daily of the angiotensin-receptor blocker (ARB) losartan—standard practice in patients with diabetes.
- The patients were randomized to also receive 10-40 mg daily of the angiotensin-converting enzyme (ACE) inhibitor lisinopril or a placebo.
- The results showed that there was a greater than twofold increase in the risk of hyperkalemia in the group that received the ARB and ACE treatments, compared with the placebo group (6.3 vs. 2.6 events/100 person-years).
- It was also shown that there was a substantial increase in the risk of acute kidney injury in the group that received both the ARB and ACE treatments than the group that received the placebo (12.2 vs. 6.7 event/100 person-years).
- Treatment with medications that block angiotensin are known to slow loss of kidney function in individuals with diabetes and proteinuria—ARB and ACE are used for such purposes; it is when these medications are combined that there is a high risk for further serious ailments.
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