Effect of angiotensin converting enzyme inhibitoron glomerular hyperfiltration in patients with type 1 diabetes

Abstract

Objective:To assess the effect of angiotensin converting enzyme inhibition on glomerular filtration rate (GFR) in normotensive patient with type 1 diabetes.Methods:A two year non-placebo control prospective study was conducted after ethical approval at Diabetes Centre of Diabetic Association of Pakistan, a WHO collaborating centre in Karachi, Pakistan. All patients with type 1 diabetes visited the out-patients department from August 2009 till July 2011 and those who fulfilled the inclusion criteria were invited to participate. A total of 121 people aged ≥18 years and ≥ 5 years of diabetes were included. Pregnant and lactating woman and those aged <18 years were excluded. GFR was calculated by using CKD-EPI formula (eGFR) at baseline and after two year. On the basis of estimated GFR, patients at baseline were divided according to KDIGO classification of chronic kidney diseases into, hyperfiltration (eGFR ≥ 100 ml/min) and normal filtration group (eGFR < 100 ml/min). All subjects in hyperfiltration group received ACE inhibitor (treatment group) while patients with normal filtration did not receive ACE inhibitor (control group).Results:Fifty two patients (43%) were in the treatment and sixty nine (57%) were in the control group. At baseline eGFR, systolic and diastolic blood pressures between groups were non-significantly different. After two years, compared to baseline, eGFR of the treatment group declined and the control group increased significantly. No significant difference in systolic while diastolic blood pressure of the treatment group increased significantly after two years compared to baseline. In contrast both systolic and diastolic blood pressure of control group increased significantly after two years compared to their baseline values.Conclusion:Present study demonstrated that initiation of ACEI in hyperfiltration stage declined GFR and keep blood pressure within normal range.

Kidney Function After a Hypertensive Disorder of Pregnancy: A Longitudinal Study

“…An effect of this interaction might be expected because hyperfiltration, which is reported in formerly preeclamptic women, 10 influences the effect of ACE inhibitor/ARB on eGFR. 20 All analyses were performed using an exchangeable correlation matrix structure, assuming a fixed correlation between measurements. In all analyses, P < 0.05 indicated statistical significance.…”

The effect of Dapagliflozin on renal functions in hospitalized patients with Acute Heart Failure

“… 11 GFR is the most reliable clinical indicator to measure renal functions as it emulates the functioning of nephrons. 12 An acute but reversible decline in eGFR referred as GFR ‘dip’ has been linked to the usage of SGLT2 inhibitors in CHF. 13 Keeping this in consideration we evaluated eGFR in our study and demonstrated that a similar trend of transient rebuff was observed by both groups which was insignificant when compared between groups.…”

“… 11 Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation was employed to calculate eGFR by using serum creatinine levels. 12 Secondary outcomes included weight loss during hospitalization, dose of furosemide, and length of hospital stay.…”