Patients with diabetes can continue to take angiotensin converting enzyme (ACE) inhibitors, even if they experience a moderate increase in serum creatinine, a consultant nephrologist advised recently.
Dr Chris Isles (Dumfries and Galloway Royal infirmary) told participants at a nephrology symposium held in Tewkesbury, Gloucestershire, that a recent meta-analysis of 12 trials had studied renal disease progression in patients taking ACE inhibitors. Five involved diabetic patients and seven non-diabetic patients, with baseline creatinine levels ranging from 133-265µmol/L.
The patients were followed up for an average of three years. An increase in serum creatinine of up to 30 per cent in the first two months was associated with long-term preservation of renal function and the message was "keep going with it", he said. However, a greater than 50 per cent increase in serum creatinine in the first four weeks was associated with bilateral renovascular disease and volume depletion. He advised monitoring patients before and during therapy. Dr Isles was concerned that diabetic nephropathy, while common, was poorly managed. A "disappointingly" high number of patients were being treated with glibenclamide, metformin or fibrates, which were inappropriate for their level of renal function. In 70 per cent of cases, referral to a nephrologist was deemed to be too late with the patient having a serum creatinine of over 200 µmol/L. In addition, nearly half of patients for whom ACE inhibitors were not contraindicated were not receiving these drugs.
There was compelling evidence that good glucose control and ACE inhibition could prevent, or at least delay, the onset of diabetic nephropathy and progressive renal failure in both type 1 and 2 diabetes, he concluded.
The nephrology symposium was sponsored by Roche Products UK Ltd. -Contributed.