Effects of the Renin-Angiotensin System Blockade on Hemoglobin Levels in Type 2 Diabetic Patients With Chronic Kidney Disease

Abstract

Treatment with angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin-receptor blockers (ARBs) may be associated with reduced erythrocyte production in several clinical settings; however, these effects have not been determined in diabetic patients with chronic kidney disease (CKD), a high-risk population for anemia. We conducted a retrospective study to assess the effects of ACEIs and ARBs on hemoglobin levels in Japanese adults with type 2 diabetes and CKD. Diabetic patients with an estimated glomerular filtration rate (eGFR) 2, who filled a prescription for an ACEI or ARB, were included. Changes in hemoglobin levels after initiating treatment with an ACEI or ARB were compared using multivariate analysis of covariance (ANCOVA) and propensity-score matching to minimize the bias. A total of 201 diabetic patients, 77 treated with an ACEI and 124 treated with an ARB, fulfilled study criteria and constituted the retrospective cohort. Mean (±s.e.) change in hemoglobin (adjusted for covariates) was greater for patients treated with ARBs (−0.43 ± 0.08 g/dl) than patients treated with ACEIs (−0.11 ± 0.11 g/dl, P = 0.025) by ANCOVA. In the propensity-score cohort analysis of 57 pairs of ACEI/ARB-treated patients, a significant decrease in hemoglobin was observed in patients treated with an ARBs (−0.54 ± 1.02 g/dl (mean ± s.d.), P < 0.001), but not in patients treated with an ACEIs (−0.14 ± 0.98 g/dl, P = 0.294). Treatment with an ARB, but not ACEI, may be associated with a modest decrease in hemoglobin levels in diabetic patients with CKD.