The Combined Effect of Angiotensin Converting Enzyme Inhibitors and Angiotensin Receptor Blockers on the Progressing of Kidney Disease in Patients with Type 2 Diabetes Compared to Single Administration of Each of These Two Drugs

Document Type : Original Article (s)

Authors

1 Professor, Department of Nephrology, School of Medicine AND Nephrology Research Center, Tehran University of Medical Sciences, Tehran, Iran

2 Associate Professor, Department of Nephrology, School of Medicine, Semnan University of Medical Sciences, Semnan, Iran

3 Instructor, Department of Nutrition, School of Medicine, Zahedan University of Medical Sciences, Zahedan, Iran

4 Resident, Department of Internal Medicine, School of Medicine, Zahedan University of Medical Sciences, Zahedan, Iran

5 Department of Biology, Falavarjan Branch, Islamic Azad Uiniversity, Falavarjan, Iran

6 Professor, Department of Internal Medicine, Isfahan University of Medical Sciences, Isfahan, Iran

Abstract

Background: Inhibition of the renin-angiotensin system in patients with diabetic nephropathy can reduce proteinuria and slow down renal impairment. In this study, we aimed to evaluate the preventive effects of prescribing both angiotensin converting enzyme inhibitors (ACEI) and angiotensin receptor blockers (ARBs) for renal disease progression compared with administrating each of these two medications alone in patients with type 2 diabetes.Methods: 90 patients with diabetic nephropathy were randomized into three groups: receiving captopril, losartan, and losartan in combination with captopril. Proteinuria was measured before, 2, 6 and 12 months after intervention, and creatinine clearance was measured before and after intervention. Repeated measures ANOVA, Fisher's least significant difference (Fisher's LSD), and t-test were used for data analysis by SPSS software.Findings: Proteinuria was improved in all groups who received medication (P < 0.001). This reduction in the group who received losartan in combined to captopril was more than other groups (P = 0.026). Creatinine clearance was not significantly different between all groups.Conclusion: Administration of ACEI or ARBs reduced proteinuria in patients suffering from diabetic nephropathy (due to type 2 diabetes) but prescribing both drugs had a significantly better outcome. However, creatinine clearance was not significantly improved in any of the groups.

Keywords

References

  1. Roshan B, Stanton RC. A story of microalbuminuria and diabetic nephropathy. J Nephropathol 2013; 2(4): 234-40.
  2. Lala MA, Nazar CMJ, Lala HA, Singh JK. Interrelation between blood pressure and diabetes. J Renal Endocrinol 2015; 1(1): e05.
  3. Ghaderian SB, Hayati F, Shayanpour S, Beladi Mousavi SS. Diabetes and end-stage renal disease; a review article on new concepts. J Renal Inj Prev 2015; 4(2): 28-33.
  4. Rafieian-Kopaei M, Baradaran A. On the occasion of world diabetes day 2105; act today to change tomorrow. J Renal Endocrinol 2015; 1(1): e02.
  5. Nasri H, Behradmanesh S, Ahmadi A, Rafieian-Kopaei M. Impact of oral vitamin D (cholecalciferol) replacement therapy on blood pressure in type 2 diabetes patients; a randomized, double-blind, placebo controlled clinical trial. J Nephropathol 2014; 3(1): 29-33.
  6. Saki K, Eftekhari Z, Naghdi N, Bahmani M. Berberis vulgaris as an antihypertensive drug; berbamine and oxycontin antihypertensive active ingredients. J Prev Epidemiol 2016; 1(1): e08.
  7. Motamedi P, Dehghani N, Kiani F, Torkamaneh S, Nasri H. New concepts in diabetic kidney disease. J Nephropharmacol 2015; 4(2): 47-8.
  8. Nasri H. Antioxidant therapy for hemodialysis patients. Ann Res Antioxid 2016; 1(1): e01.
  9. Khodadadi S. Role of herbal medicine in boosting immune system. Immunopathol Persa 2015; 1(1): e01.
  10. Moradi M, Rahimi Z, Amiri S, Rahimi Z, Vessal M, Nasri H. AT1R A1166C variants in patients with type 2 diabetes mellitus and diabetic nephropathy. J Nephropathol 2015; 4(3): 69-76.
  11. Nasri H, Rafieian-Kopaei M. Diabetes mellitus and renal failure: Prevention and management. J Res Med Sci 2015; 20(11): 1112-20.
  12. Hajian S. Positive effect of antioxidants on immune system. Immunopathol Persa 2015; 1(1): e02.
  13. Nazar CMJ. Significance of diet in chronic kidney disease. J Nephropharmacol 2013; 2(2): 37-43.
  14. Beladi-Mousavi SS, Hajibabaei K, Tamadon MR, Rafieian-Kopaei M. Relationship between free radicals and risk of kidney diseases; the role of antioxidants and their reaction mechanisms. Ann Res Antioxid 2016; 1(1): e02.
  15. Nazar CMJ. Mechanism of hypertension in diabetic nephropathy. J Nephropharmacol 2014; 3(2): 49-55.
  16. Amiri M, Hosseini SM. Diabetes mellitus type 1; is it a global challenge? Acta Epidemioendocrinol. 2016;1(1):e02.
  17. Nasri H, Shirzad H, Baradaran A, Rafieian-Kopaei M. Antioxidant plants and diabetes mellitus. J Res Med Sci 2015; 20(5): 491-502.
  18. Mirhoseini M, Baradaran A, Rafieian-Kopaei M. Medicinal plants, diabetes mellitus and urgent needs. J HerbMed Pharmacol 2013; 2(2): 53-4.
  19. Nasri H, Abedi-Gheshlaghi Z, Rafieian-Kopaei M. Curcumin and kidney protection; current findings and new concepts. Acta Persica Pathophysiol 2016; 1(1): e01.
  20. Hajivandi A, Amiri M. World kidney day 2014: kidney disease and elderly. J Parathyr Dis 2014; 2(1): 3-4.
  21. Nasri H, Ardalan MR, Rafieian-Kopaei M. On the occasion of world hypertension day 2014. J Parathyr Dis 2014; 2(1): 5-6.
  22. Wiernsperger N. Metformin as a cellular protector; a synoptic view of modern evidences. J Nephropharmacol 2015; 4(1): 31-6.
  23. Momeni A. Cardiovascular complications of renal failure in hemodialysis patients. Ann Res Dial 2016; 1(1): e05.
  24. Nasri H, Ardalan MR, Rafieian-Kopaei M. Mechanistic impacts of medicinal plants in diabetic kidney disease. Iran J Public Health 2014; 43(9): 1311-3.
  25. Dehghan Shahreza F. Mechanistic impact of renal tubular cell protection by antioxidants. Ann Res Antioxid 2016;1(1): e06.
  26. Tamadon MR, Ardalan MR, Nasri H. World kidney day 2013; acute renal injury; a global health warning. J Parathyr Dis 2013; 1(2): 27-8.
  27. Rasregari F. The healthy diet for cardiovascular disease. Acta Persica Pathophysiol 2016; 1(1): e02.
  28. Wild S, Roglic G, Green A, Sicree R, King H. Global prevalence of diabetes: Estimates for the year 2000 and projections for 2030. Diabetes Care 2004; 27(5): 1047-53.
  29. Baradaran A. Lipoprotein(a), type 2 diabetes and nephropathy; the mystery continues. J Nephropathol 2012; 1(3): 126-9.
  30. Fallahzadeh MH, Fallahzadeh MA. On the occasion of World Kidney Day 2016; renal disease in children. Acta Persica Pathophysiol 2016; 1(1): e04.
  31. Momeni A, Nasri H. Concurrent diabetic nephropathy and C1q nephropathy in a young male patient: The first report in literature. J Nephropathol 2013; 2(3): 201-3.
  32. Rossing K, Jacobsen P, Pietraszek L, Parving H. Renoprotective effects of adding angiotensin II receptor blocker to maximal recommended doses of ACE inhibitor in diabetic nephropathy. Diabetes Care 2003; 26(8): 2268-74.
  33. Tamadon MR, Baradaran A, Rafieian-Kopaei M. Antioxidant and kidney protection; differential impacts of single and whole natural antioxidants. J Renal Inj Prev 2013; 3(2): 41-2.
  34. Junaid Nazar C, Kindratt TB, Ahtizaz Ahmad S, Ahmed M, Anderson J. Barriers to the successful practice of chronic kidney diseases at the primary health care level; a systematic review. J Renal Inj Prev 2014; 3(3): 61-7.
  35. Nasri H, Rafieian-Kopaei M. Kidney tubular cell protection; recent findings. Iran J Pediatr 2014; 24(6): 781-3.
  36. Komine N, Khang S, Wead LM, Blantz RC, Gabbai FB. Effect of combining an ACE inhibitor and an angiotensin II receptor blocker on plasma and kidney tissue angiotensin II levels. Am J Kidney Dis 2002; 39(1): 159-64.
  37. Roozbeh J, Sagheb MM, Vafaie E. The association between blood pressure level and serum uric acid concentration in hemodialysis patients. J Nephropathol 2015; 4(3): 85-90.
  38. Nasri H, Baradaran A. Correlation of serum magnesium with dyslipidemia in maintenance hemodialysis patients. Acta Medica (Hradec Kralove) 2004; 47(4): 263-5.
  39. Kadkhodaee M, Sedaghat Z. Novel renoprotection methods by local and remote conditioning. J Renal Inj Prev 2014; 3(2): 37-8.
  40. Rouhi H, Ganji F. Effects of N-acetyl cysteine on serum lipoprotein (a) and proteinuria in type 2 diabetic patients. J Nephropathol 2013; 2(1): 61-6.
  41. Beladi-Mousavi S, Bashardoust B, Nasri H, Ahmadi A, Tolou-Ghamari Z, Hajian S, et al. The theme of the world diabetes day 2014; healthy living and diabetes; a nephrology viewpoint. J Nephropharmacol 2014; 3(2): 43-5.
  42. Rafieian-Kopaei M, Behradmanesh S, Kheiri S, Nasri H. Association of serum uric acid with level of blood pressure in type 2 diabetic patients. Iran J Kidney Dis 2014; 8(2): 152-4.
  43. Brenner BM, Cooper ME, de Zeeuw D, Grunfeld JP, Keane WF, Kurokawa K, et al. The losartan renal protection study--rationale, study design and baseline characteristics of RENAAL (Reduction of Endpoints in NIDDM with the Angiotensin II Antagonist Losartan). J Renin Angiotensin Aldosterone Syst 2000; 1(4): 328-35.
  44. Azizi M, Chatellier G, Guyene TT, Murieta-Geoffroy D, Menard J. Additive effects of combined angiotensin-converting enzyme inhibition and angiotensin II antagonism on blood pressure and renin release in sodium-depleted normotensives. Circulation 1995; 92: 825-34.
  45. Tavafi M. Diabetic nephropathy and antioxidants. J Nephropathol 2013; 2(1): 20-7.
  46. Hajivandi A, Amiri M. World Diabetes Day 2013: diabetes mellitus and nephrology. J Nephropharmacol 2013; 2(2): 31-2.
  47. Nasri H, Mubarak M. Extracapillary proliferation in IgA nephropathy; recent findings and new ideas. J Nephropathol 2015; 4(1): 1-5.
  48. Spasovski D. Renal markers for assessment of renal tubular and glomerular dysfunction. J Nephropharmacol 2013; 2(2): 23-5.
  49. Laight DW. Therapeutic inhibition of the renin angiotensin aldosterone system. Expert Opin Ther Pat 2009; 19(6): 753-9.
  50. The Diabetes Control and Complications (DCCT) Research Group. Effect of intensive therapy on the development and progression of diabetic nephropathy in the Diabetes Control and Complications Trial. The Diabetes Control and Complications (DCCT) Research Group. Kidney Int 1995; 47(6): 1703-20.
  51. Parving HH, Lehnert H, Brochner-Mortensen J, Gomis R, Andersen S, Arner P. The effect of irbesartan on the development of diabetic nephropathy in patients with type 2 diabetes. N Engl J Med 2001; 345(12): 870-8.
  52. Bjorck S, Mulec H, Johnsen SA, Norden G, Aurell M. Renal protective effect of enalapril in diabetic nephropathy. BMJ 1992; 304(6823): 339-43.
  53. Shahbazian HA, Shahbazian HB, Feghhi M, Ehsanpour A. A study on the effect of dual blockade of rennin and angiotensin systems in control of diabetic nephropathy in patients with type 2 diabetic patients. Jundishapur Sci Med J 2008; 7(1): 85-91. [In Persian].
  54. Luno J, Barrio V, Goicoechea MA, Gonzalez C, de Vinuesa SG, Gomez F, et al. Effects of dual blockade of the renin-angiotensin system in primary proteinuric nephropathies. Kidney Int Suppl 2002; (82): S47-52.
  55. Keane WF, Brenner BM, de Zeeuw D, Grunfeld JP, McGill J, Mitch WE, et al. The risk of developing end-stage renal disease in patients with type 2 diabetes and nephropathy: The RENAAL Study. Kidney International 2003; 63(4): 1499-507.
  56. Dehghan Shahreza F. From oxidative stress to endothelial cell dysfunction. J Prev Epidemiol 2016; 1(1): e04.
  57. Winkelmayer WC, Fischer MA, Schneeweiss S, Wang PS, Levin R, Avorn J. Underuse of ACE inhibitors and angiotensin II receptor blockers in elderly patients with diabetes. Am J Kidney Dis 2005; 46(6): 1080-7.
  58. Weinberg MS, Weinberg AJ, Cord R, Zappe DH. The effect of high-dose angiotensin II receptor blockade beyond maximal recommended doses in reducing urinary protein excretion. Journal of Renin-Angiotensin-Aldosterone System 2001; 2(1 Suppl): S196-S198.
  59. Baradaran A, Madihi Y, Merrikhi, AR, Rafieian-Kopaei M, Nasri H. Serum lipoprotein (a) in diabetic patients with various renal function not yet on dialysis. Pak J Med Sci 2013; 29(1): 354-7.
  60. Brenner BM, Cooper ME, de Zeeuw D, Keane WF, Mitch WE, Parving HH, et al. Effects of losartan on renal and cardiovascular outcomes in patients with type 2 diabetes and nephropathy. N Engl J Med 2001; 345(12): 861-9.
  61. Lewis EJ, Hunsicker LG, Clarke WR, Berl T, Pohl MA, Lewis JB, et al. Renoprotective effect of the angiotensin-receptor antagonist irbesartan in patients with nephropathy due to type 2 diabetes. N Engl J Med 2001; 345(12): 851-60.
  62. Tan F, Mukherjee JJ, Lee KO, Lim P, Liew CF. Dual blockade of the renin-angiotensin-aldosterone system is safe and effective in reducing albuminuria in Asian type 2 diabetic patients with nephropathy. Singapore Med J 2010; 51(2): 151-6.
  63. Titan SM, Vieira M, Dominguez WV, Barros RT, Zatz R. ACEI and ARB combination therapy in patients with macroalbuminuric diabetic nephropathy and low socioeconomic level: a double-blind randomized clinical trial. Clin Nephrol 2011; 76(4): 273-83.
  64. Molitch ME, de Fronzo RA, Franz MJ, Keane WF, Mogensen CE, Parving HH, et al. Nephropathy in diabetes. Diabetes Care 2004; 27(Suppl 1): S79-S83.
  65. Aleebrahim-Dehkordy E, Khodadadi S, Mousavipanah Z, Nasri H. Herbal antioxidant and kidney. Ann Res Antioxid 2016; 1(1): e10.
  66. Nasri H, Tavakoli M, Ahmadi A, Baradaran A, Nematbakhsh M, Rafieian-Kopaei M. Ameliorative effect of melatonin against contrast media induced renal tubular cell injury. Pak J Med Sci 2014; 30(2): 261-5.
  67. Nasri H. Herbal drugs and new concepts on its use. J Prev Epidemiol 2016; 1(1): e01.
  68. Nasri H, Baradaran A. B-mode ultrasonography of carotid and femoral arteries for calcified plaques in chronic renal failure, hemodialysis and kidney transplant patients. Hong Kong Journal of Nephrology 2004; 6(2): 109-11.
  69. Madihi Y, Merrikhi AR, Baradaran A, Rafieian-Kopaei M, Shahinfard N, Ansari R, et al. Impact of Sumac on postprandialhigh-fat oxidative stress. Pak J Med Sci 2013; 29(1 Suppl): 340-5.
  70. Nasri H, Sajjadieh S, Mardani S, Momeni A, Merikhi A, Madihi Y, et al. Correlation of immunostaining findings with demographic data and variables of Oxford classification in IgA nephropathy. J Nephropathol 2013; 2(3): 190-5.
  71. Baradaran A, Madihi Y, Merrikhi A, Rafieian-Kopaei M, Nematbakhsh M, Asgari A, et al. Nephrotoxicity of hydroalcoholic extract of Teucrium polium in Wistar rats. Pak J Med Sci 2013; 29(1 Suppl): 329-33.
  72. Rafieian-Kopaei M, Nasri H, Nematbakhsh M, Baradaran A, Gheissari A, Rouhi H, et al. Erythropoietin ameliorates genetamicin-induced renal toxicity: A biochemical and histopathological study. J Nephropathol 2012; 1(2): 109-16.
  73. Behradmanesh S, Horestani MK, Baradaran A, Nasri H. Association of serum uric acid with proteinuria in type 2 diabetic patients. J Res Med Sci 2013; 18(1): 44-6.
  74. Schleich F, Krzesinski JM, Pierard L, Scheen AJ. How I treat... by optimizing the blockade of the renin-angiotensin-aldosterone system. Rev Med Liege 2008; 63(4): 174-81.
  75. Arici M, Erdem Y. Dual blockade of the renin-angiotensin system for cardiorenal protection: an update. American Journal of Kidney Diseases 2009; 53(2): 332-45.
  76. Cordell H, Todd JA. Multifactorial inheritance in type 1 diabetes. Trends in Genetics 1995; 11(12): 499-504.
  77. Rafieian-Kopaei M, Baradaran A, Rafieian M. Plants antioxidants: From laboratory to clinic. J Nephropathol 2013; 2(2): 152-3.
Journal of Isfahan Medical School
Volume 34, Issue 369 - Serial Number 369
January and February 2016
Pages 1-10

Files

History

  • Receive Date: 14 October 2015
  • Revise Date: 01 November 2024
  • Accept Date: 06 April 2022

Share

How to cite

Statistics