Purpose: 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


中文翻译：

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血管紧张素受体阻滞剂和血管紧张素转换酶抑制剂对印度尼西亚 2 型糖尿病合并高血压患者肾功能和血钾水平的影响：为期三个月的队列研究

目的：印度尼西亚的国家处方集限制 (2019) 要求估计的肾小球滤过率 (eGFR) 低于 60 mL/min/1.73 m ²能够开出替米沙坦和缬沙坦以及 ACE-I 不耐受 能够开出厄贝沙坦和坎地沙坦。这些限制是基于经济考虑，不同于美国糖尿病协会 (ADA) (2020) 指南，该指南允许无限制地平等使用血管紧张素 II 受体阻滞剂 (ARB) 和血管紧张素转换酶抑制剂 (ACE-I)。由于需要评估 ACE-I 和 ARB 在印度尼西亚高血压 2 型糖尿病 (T2DM) 人群中的不同影响，我们比较了它们对尿白蛋白肌酐比 (UACR)、估计肾小球滤过率的影响。 eGFR）和血钾水平。
患者和方法：在 RSUPN Cipto Mangunkusumo 医生医院对 123 名 T2DM 患者进行了一项前瞻性队列研究。我们使用经过验证的问卷、健康记录和实验室数据对研究对象进行了为期三个月的前瞻性跟踪。
结果：观察 3 个月后，除 ACE-I 组 BMI 值升高（p = 0.046）和 ARB 组 LDL 值（p = 0.016）和 HDL 值（p = 0.004）降低外，没有显着变化。多变量分析表明，ACE-I 或 ARB 的消耗与 UACR 的降低/恒定或钾水平的升高无关，即使在通过混杂变量进行调整后也是如此。有趣的是，我们发现 ARB 更有可能增加 eGFR，但一旦将 ACE-I/ARB 使用的持续时间输入模型，其意义就消失了。此外，BMI > 25 kg/m ²是与 UACR 降低/恒定相关的重要因素，男性对 eGFR 增加具有显着意义，而收缩压对钾水平升高具有显着意义。
结论：ACE-I 和 ARB 对 UACR 和血钾水平的影响相似，但在服用三个月内，与 ACE-I 相比，ARB 略微增加了 eGFR。

关键词： 2型糖尿病，UACR，eGFR，慢性肾脏病，血管紧张素转换酶抑制剂，血管紧张素Ⅱ受体阻滞剂