Abstract

INHIBITORS AND BLOCKERS OF RENIN-ANGIOTENSIN SYSTEM IN THE PREVENTION AND IN DELAYING THE PROGRESSION OF DIABETIC NEPHROPATHY – A COMPARATIVE STUDY

Diabetic nephropathy is the leading cause of End Stage Renal Disease (ESRD) worldwide. Angiotensin Converting Enzyme Inhibitors (ACEI), Angiotensin Receptor Blockers (ARB) are currently employed antihypertensives in the prevention of diabetic nephropathy. This study was done to evaluate & to compare the efficacy, safety and phamacoeconomics of the antihypertensives, ACEI and ARB in the prevention as well as in delaying the progression of diabetic nephropathy. A total of 108 diabetic nephropathy patients with mean age group of 57.26± 9.77 years were selected for the study after obtaining informed consent. They were divided into 2 groups, ACEI group and ARB group. Patient history interview was done. The Laboratory data such as Serum Creatinine, estimated Glomerular Filtration Rate (eGFR), and Total Protein Excretion in 24hrs Urine sample and Microalbuminuria were collected at initial level and after a period of treatment. The data were analyzed using suitable statistical methods. Serum creatinine reduced with mean change of 0.1 % in ARB group and increased by 0.29% in ACEI group. With respect to eGFR, ACEI and ARB groups show 0.08 % and 1.87 % improvement respectively. ARB shows 34.16% of mean change in reduction of total protein excretion but in ACEI group it was only 4.38%. In Microalbuminuria, among the ACEI group, the albumin remain stable from baseline to review in 84.38% of patients and reduced in 6.25% but in ARB group 40.79% are stable and 51.32% shows reduction. All these three parameters viz. Serum creatinine , eGFR and Protein excretion, ACEI is effective but ARB are more effective and shows significant changes especially in proteinuric patients. Treatment either with ACEI or ARB at the earliest will be safe and cost benefit as it will delay the dialysis and transplantation which are more expensive