End-stage renal disease and adherence to angiotensin-converting enzyme inhibitors and angiotensin receptor blockers among patients with diabetes

Michal Shani, Shlomo Vinker, Leonid Feldman

Research output: Contribution to journalArticlepeer-review

Abstract

Angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) have become standards of care for diabetic nephropathy. The authors assessed the association between treatment adherence to ACEIs and ARBs and the development of end-stage renal disease (ESRD). The cohort comprised the 9895 members of the Central District of Clalit Health Services aged 40 to 70 years, diagnosed with diabetes before 2002, who filled at least four ACEI or ARB monthly prescriptions during 2002–2011. Forty-six percent of patients made 10 or more purchases a year. Hazard ratios for ESRD development and death decreased as adherence increased, with no evidence of a cutoff threshold or plateau. For both outcomes, hazard ratios were significantly lower among patients who purchased at least 10 monthly prescriptions (83% adherence), after adjusting for age, sex, and a number of clinically relevant factors. While ACEIs/ARBs have become standards of care in diabetes, treatment adherence is essential to achieve full benefit.

Original languageEnglish
Pages (from-to)627-631
Number of pages5
JournalJournal of Clinical Hypertension
Volume19
Issue number6
DOIs
StatePublished - Jun 2017

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