Relative effects of angiotensin converting enzyme inhibitors and calcium antagonists in advanced diabetic nephropathy.

OBJECTIVE

We have previously observed that calcium antagonists (CA) were associated with poorer renal survival in African Americans (AA) with diabetic nephropathy (DN). Here, we investigate further the effects of CA alone, or in combination with angiotensin converting enzyme inhibitors (ACEI) in advanced DN.

DESIGN

Retrospective study.

SETTING

Academic nephrology clinic.

PATIENTS

1. Patients who entered the endstage renal disease (ESRD) program in years 1993-1998 with a primary diagnosis of DN. 2) A cross-sectional analysis of pre-ESRD patients with DN, first seen in the clinic in 1996, then followed until 2000. Over 80% of patients were AA, and approximately 75% were female in both cohorts.

INTERVENTIONS

Patients were categorized according to whether they were on either an ACEI or a CA, alone, or a combination of these, at presentation to the clinic, and during follow up.

MAIN OUTCOME MEASURES

Renal survival (time to ESRD) and effects on blood pressure.

RESULTS

In both data sets, patients presented with advanced renal disease. Those on CA tended to have lower blood pressure on presentation, and during follow up, and were more likely to experience a significant decrease in blood pressure over the course of follow up. Using a Cox proportional hazards model, ACEI-CA status was not found to be significantly associated with renal survival.

CONCLUSIONS

Calcium antagonists (CA) are effective at lowering blood pressure in advanced DN, and do not appear to negatively affect renal survival, especially when combined with an ACEI.