Effect of Angiotensin Receptor Blocker and Angiotensin Converting Enzyme Inhibitor on Kidney Function and Blood Potassium Level in Indonesian Type 2 Diabetes Mellitus with Hypertension: A Three-Month Cohort Study

Febriana M Puspita,1 Em Yunir,2 Putri S Agustina,1 Rani Sauriasari1 1Faculty of Pharmacy, Universitas Indonesia, Depok, Indonesia; 2Department of Internal Medicine, Faculty of Medicine, Universitas Indonesia, Jakarta, IndonesiaCorrespondence: Rani SauriasariFaculty of Pharmacy, Universitas Indonesia...

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Autores principales:	Puspita FM, Yunir E, Agustina PS, Sauriasari R
Formato:	article
Lenguaje:	EN
Publicado:	Dove Medical Press 2021
Materias:	type 2 diabetes mellitus uacr egfr chronic kidney disease angiotensin-converting enzyme inhibitors angiotensin ii receptor blockers Specialties of internal medicine RC581-951
Acceso en línea:	https://doaj.org/article/33181feee3a6483aa78e2724e3a8f8b1
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spelling	oai:doaj.org-article:33181feee3a6483aa78e2724e3a8f8b12021-12-02T14:55:28ZEffect of Angiotensin Receptor Blocker and Angiotensin Converting Enzyme Inhibitor on Kidney Function and Blood Potassium Level in Indonesian Type 2 Diabetes Mellitus with Hypertension: A Three-Month Cohort Study1178-7007https://doaj.org/article/33181feee3a6483aa78e2724e3a8f8b12021-09-01T00:00:00Zhttps://www.dovepress.com/effect-of-angiotensin-receptor-blocker-and-angiotensin-converting-enzy-peer-reviewed-fulltext-article-DMSOhttps://doaj.org/toc/1178-7007Febriana M Puspita,1 Em Yunir,2 Putri S Agustina,1 Rani Sauriasari1 1Faculty of Pharmacy, Universitas Indonesia, Depok, Indonesia; 2Department of Internal Medicine, Faculty of Medicine, Universitas Indonesia, Jakarta, IndonesiaCorrespondence: Rani SauriasariFaculty of Pharmacy, Universitas Indonesia, Depok, 16424, IndonesiaTel +62-21-7270031Fax +62-21-7863433Email rani@farmasi.ui.ac.idPurpose: National formulary restrictions in Indonesia (2019) require estimated glomerular filtration rate (eGFR) of less than 60 mL/min/1.73 m2 to be able to prescribe telmisartan and valsartan and ACE-I intolerance to be able to prescribe irbesartan and candesartan. These restrictions are based on economic considerations and differ from American Diabetes Association (ADA) (2020) guidelines which allow equal use of angiotensin II receptor blockers (ARB) and angiotensin-converting enzyme inhibitors (ACE-I) without restriction. Since there is a need to evaluate the different effects of ACE-I and ARB in the Indonesian hypertensive type 2 diabetes mellitus (T2DM) population, we compare their effects on urine albumin-to-creatinine ratio (UACR), estimated glomerular filtration rate (eGFR), and blood potassium level.Patients and Methods: A prospective cohort study at RSUPN Dr. Cipto Mangunkusumo Hospital was conducted in 123 T2DM patients. We followed the study subjects prospectively for three months using a validated questionnaire, health record, and laboratory data.Results: After 3 months of observation, there were no significant changes, except increased BMI values (p = 0.046) in the ACE-I group, and decreased LDL value (p = 0.016) and HDL value (p = 0.004) in the ARB group. Multivariate analysis showed that the consumption of ACE-I or ARB was not associated with a decrease/constant of UACR or increase potassium level, even after adjusting by confounding variables. Interestingly, we found ARB was more likely to increase eGFR, but the significance was lost once the duration of ACE-I/ARB use was entered into the model. In addition, BMI > 25 kg/m2 was a significant factor associated with decreased/constant UACR, maleness was significant for increased eGFR, and declining systolic blood pressure for increase in potassium level.Conclusion: ACE-I and ARB have a similar effect on UACR and blood potassium level, but ARB slightly increased eGFR compared to ACE-I within three months of consumption.Keywords: type 2 diabetes mellitus, UACR, eGFR, chronic kidney disease, angiotensin-converting enzyme inhibitors, angiotensin II receptor blockersPuspita FMYunir EAgustina PSSauriasari RDove Medical Pressarticletype 2 diabetes mellitusuacregfrchronic kidney diseaseangiotensin-converting enzyme inhibitorsangiotensin ii receptor blockersSpecialties of internal medicineRC581-951ENDiabetes, Metabolic Syndrome and Obesity: Targets and Therapy, Vol Volume 14, Pp 3841-3849 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	type 2 diabetes mellitus uacr egfr chronic kidney disease angiotensin-converting enzyme inhibitors angiotensin ii receptor blockers Specialties of internal medicine RC581-951
spellingShingle	type 2 diabetes mellitus uacr egfr chronic kidney disease angiotensin-converting enzyme inhibitors angiotensin ii receptor blockers Specialties of internal medicine RC581-951 Puspita FM Yunir E Agustina PS Sauriasari R Effect of Angiotensin Receptor Blocker and Angiotensin Converting Enzyme Inhibitor on Kidney Function and Blood Potassium Level in Indonesian Type 2 Diabetes Mellitus with Hypertension: A Three-Month Cohort Study
description	Febriana M Puspita,1 Em Yunir,2 Putri S Agustina,1 Rani Sauriasari1 1Faculty of Pharmacy, Universitas Indonesia, Depok, Indonesia; 2Department of Internal Medicine, Faculty of Medicine, Universitas Indonesia, Jakarta, IndonesiaCorrespondence: Rani SauriasariFaculty of Pharmacy, Universitas Indonesia, Depok, 16424, IndonesiaTel +62-21-7270031Fax +62-21-7863433Email rani@farmasi.ui.ac.idPurpose: National formulary restrictions in Indonesia (2019) require estimated glomerular filtration rate (eGFR) of less than 60 mL/min/1.73 m2 to be able to prescribe telmisartan and valsartan and ACE-I intolerance to be able to prescribe irbesartan and candesartan. These restrictions are based on economic considerations and differ from American Diabetes Association (ADA) (2020) guidelines which allow equal use of angiotensin II receptor blockers (ARB) and angiotensin-converting enzyme inhibitors (ACE-I) without restriction. Since there is a need to evaluate the different effects of ACE-I and ARB in the Indonesian hypertensive type 2 diabetes mellitus (T2DM) population, we compare their effects on urine albumin-to-creatinine ratio (UACR), estimated glomerular filtration rate (eGFR), and blood potassium level.Patients and Methods: A prospective cohort study at RSUPN Dr. Cipto Mangunkusumo Hospital was conducted in 123 T2DM patients. We followed the study subjects prospectively for three months using a validated questionnaire, health record, and laboratory data.Results: After 3 months of observation, there were no significant changes, except increased BMI values (p = 0.046) in the ACE-I group, and decreased LDL value (p = 0.016) and HDL value (p = 0.004) in the ARB group. Multivariate analysis showed that the consumption of ACE-I or ARB was not associated with a decrease/constant of UACR or increase potassium level, even after adjusting by confounding variables. Interestingly, we found ARB was more likely to increase eGFR, but the significance was lost once the duration of ACE-I/ARB use was entered into the model. In addition, BMI > 25 kg/m2 was a significant factor associated with decreased/constant UACR, maleness was significant for increased eGFR, and declining systolic blood pressure for increase in potassium level.Conclusion: ACE-I and ARB have a similar effect on UACR and blood potassium level, but ARB slightly increased eGFR compared to ACE-I within three months of consumption.Keywords: type 2 diabetes mellitus, UACR, eGFR, chronic kidney disease, angiotensin-converting enzyme inhibitors, angiotensin II receptor blockers
format	article
author	Puspita FM Yunir E Agustina PS Sauriasari R
author_facet	Puspita FM Yunir E Agustina PS Sauriasari R
author_sort	Puspita FM
title	Effect of Angiotensin Receptor Blocker and Angiotensin Converting Enzyme Inhibitor on Kidney Function and Blood Potassium Level in Indonesian Type 2 Diabetes Mellitus with Hypertension: A Three-Month Cohort Study
title_short	Effect of Angiotensin Receptor Blocker and Angiotensin Converting Enzyme Inhibitor on Kidney Function and Blood Potassium Level in Indonesian Type 2 Diabetes Mellitus with Hypertension: A Three-Month Cohort Study
title_full	Effect of Angiotensin Receptor Blocker and Angiotensin Converting Enzyme Inhibitor on Kidney Function and Blood Potassium Level in Indonesian Type 2 Diabetes Mellitus with Hypertension: A Three-Month Cohort Study
title_fullStr	Effect of Angiotensin Receptor Blocker and Angiotensin Converting Enzyme Inhibitor on Kidney Function and Blood Potassium Level in Indonesian Type 2 Diabetes Mellitus with Hypertension: A Three-Month Cohort Study
title_full_unstemmed	Effect of Angiotensin Receptor Blocker and Angiotensin Converting Enzyme Inhibitor on Kidney Function and Blood Potassium Level in Indonesian Type 2 Diabetes Mellitus with Hypertension: A Three-Month Cohort Study
title_sort	effect of angiotensin receptor blocker and angiotensin converting enzyme inhibitor on kidney function and blood potassium level in indonesian type 2 diabetes mellitus with hypertension: a three-month cohort study
publisher	Dove Medical Press
publishDate	2021
url	https://doaj.org/article/33181feee3a6483aa78e2724e3a8f8b1
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Effect of Angiotensin Receptor Blocker and Angiotensin Converting Enzyme Inhibitor on Kidney Function and Blood Potassium Level in Indonesian Type 2 Diabetes Mellitus with Hypertension: A Three-Month Cohort Study

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