The renin-angiotensin-aldosterone system blockade in patients with advanced diabetic kidney disease.
BACKGROUND AND OBJECTIVES
Diabetic kidney disease is the leading cause of end-stage chronic kidney disease. The renin-angiotensin-aldosterone system (RAAS) blockade has been shown to slow the progression of diabetic kidney disease. Our objectives were: to study the percentage of patients with diabetic kidney disease treated with RAAS blockade, to determine its renal function, safety profile and assess whether its administration is associated with increased progression of CKD after 3 years of follow-up.


MATERIALS AND METHODS
Retrospective study. 197 diabetic kidney disease patients were included and divided into three groups according to the treatment: patients who had never received RAAS blockade (non-RAAS blockade), patients who at some point had received RAAS blockade (inconstant-RAAS blockade) and patients who received RAAS blockade (constant-RAAS blockade). Clinical characteristics and analytical variables such as renal function, electrolytes, glycosylated haemoglobin and glomerular filtration rate according to chronic kidney disease -EPI and MDRD formulas were assessed. We also studied their clinical course (baseline, 1 and 3 years follow-up) in terms of treatment group, survival, risk factors and renal prognosis.


RESULTS
Non-RAAS blockade patients had worse renal function and older age (p<0.05) at baseline compared to RAAS blockade patients. Patients who received RAAS blockade were not found to have greater toxicity or chronic kidney disease progression and no differences in renal prognosis were identified. Mortality was higher in non-RAAS blockade patients, older patients and patients with worse renal function (p<0.05). In the multivariate analysis, older age and worse renal function were risk factors for mortality.


CONCLUSIONS
Treatment with RAAS blockade is more common in diabetic kidney disease patients with eGFR≥30ml/min/1.73m2. In our study, there were no differences in the evolution of renal function between the three groups. Older age and worse renal function were associated with higher mortality in patients who did not receive RAAS blockade.
['Bermejo|Sheila|S|', 'García|Carles Oriol|CO|', 'Rodríguez|Eva|E|', 'Barrios|Clara|C|', 'Otero|Sol|S|', 'Mojal|Sergi|S|', 'Pascual|Julio|J|', 'Soler|María José|MJ|']
D000368:Aged D000369:Aged, 80 and over D057911:Angiotensin Receptor Antagonists D000806:Angiotensin-Converting Enzyme Inhibitors D003404:Creatinine D003928:Diabetic Nephropathies D005260:Female D005500:Follow-Up Studies D005919:Glomerular Filtration Rate D006801:Humans D053208:Kaplan-Meier Estimate D008297:Male D000451:Mineralocorticoid Receptor Antagonists D016016:Proportional Hazards Models D017582:Renal Replacement Therapy D012084:Renin-Angiotensin System D012189:Retrospective Studies
Renin-angiotensin-aldosterone system blockade Diabetic kidney disease Chronic kidney disease Bloqueo del sistema renina-angiotensina-aldosterona Diabetes mellitus Enfermedad renal crónica Enfermedad renal diabética