A REVISETED STUDY OF ACE, ARB AND COMBINATION OF BOTH IN TREATMENT OF TYPE -2 DIABETIC NEPHROPATHY.

Abstract

Introduction – India known as diabetic capital of the World. Worldwide the leading cause of ESRD in Diabetic Nephropathy.ACE inhibitors are ARBs are used to reduce the proteinuria and to prevent decline in GFR in individual suffering from Type 1 or Type 2 DM. Combined use of both ACE inhibitor and ARB has proven results in decrease of proteinuria. However, there remain concerns over safety of combination use. Further whether there is any additional benefit of combination use on effect on progression of Kidney disease remains questionable. This issue has long been debated and several studies have been conducted to answer this question. This study tries to revisit the same question.

Material and Methods – Study was carried on 150 patients presenting with Type 2 diabetic patient suffering from microalbuminuria at Department of Cardiology, RIMS (A tertiary care hospital) during the period January2018 to June2018. Group A- 50 Pt were replaced with Ramipril, Group -B 50 Pt were placed on Olmesartan and Group C -50 Pt were placed on combination of both. The primary end point was the comparison of change in Urine albumin: creatinine ratio in these groups compared to baseline level.

Result– All three groups showed significant decrease in systolic and diastolic blood pressure. All three group show significant decrease in urinary albumin creatinine ratio, maximum in combination group which was statistically significant with respect to other group. However, it is to be noted here that the combination therapy was able to control blood pressure levels most effectively and the higher decrease in albumin: creatinine ratio may be a function of better blood pressure control rather than more complete blockade of the Renin Angiotensin System. Minor increase in potassium and creatinine levels were seen in some patients but it was neither statistically significant nor necessitated discontinuation of medication.

Conclusion- 

The results of this study support the theory that the RAS has a role in progression of renal disease and a more complete blockade of RAS by ACE-1 and ARB results in better control of blood pressure and decreases albumin loss in urine.