Background: Diabetes conduces to an increased risk of deteriorating renal impairment. Renin-angiotensin-aldosterone system (RAAS) blocking agents were used to preserve renal progression among type 2 diabetes mellitus (DM) patients. However, rapid estimated glomerular filtration rate (eGFR) decline was still presented.

Objective: The present study is to identify the risk factors for rapid eGFR decline among type 2 DM patients using RAAS blocking agents, and to evaluate the impacts of RAAS blocking agents in inappropriate administration to renal events, cerebrovascular events, and coronary events.

Materials and Methods: The present study was a retrospective 2-year period study between 2016 and 2017. Patients with type 2 diabetes were treated with RAAS blocking agents. Multivariate logistic regression was used to access the risk factors of the rapid eGFR decline compared with non-rapid eGFR decline. Relative risk was obtained to evaluate the renal outcome between appropriate use of RAAS blocking agents compared with inappropriate usage.

Results: Of the total 500 patients, 195 subjects developed rapidly decreased eGFR of more than 5 mL/minute/1.73 m² over one year. Predictive factors significantly associated with rapid decline eGFR were cardiovascular disease (adjusted odds ratio [OR] 6.59; p=0.020), urine albumin creatinine ratio of more than 1000 mg/g (adjusted OR 3.31; p=0.017), and normoalbuminemia (adjusted OR 0.44; p=0.011). There was the significant association with the risk of persistent albuminuria in patients who received inappropriate RAAS blocking agents compared with patients who received appropriate RAAS blocking agents (RR 1.23; 95% CI 1.06 to 1.43).

Conclusion: Cardiovascular disease, albuminuria, and hypoalbuminemia are the major risk factors leading to rapid decline eGFR developing in type 2 DM patients who received RAAS blocking agents. Moreover, the appropriate use of RAAS blocking agents should be a concerned issue.

Keywords: Diabetic kidney disease, RAAS blocking agents, Albuminuria

DOI: doi.org/10.35755/jmedassocthai.2020.08.10603

Received 27 Aug 2019 | Revised 16 Jan 2020 | Accepted 17 Jan 2020