Prediction of worsening of renal function by the combination of an initial decline in renal function and blood pressure-lowering effect after renin-angiotensin system blockade in patients with type 2 diabetes mellitus (JDDM 83).

AIMS: This study investigated the effect of an initial decline in the estimated glomerular filtration rate (eGFR) and blood pressure lowering after renin-angiotensin system (RAS) blockade on subsequent renal function in patients with type 2 diabetes mellitus.

METHODS

A retrospective follow-up study was conducted on 5345 patients with an eGFR >60 mL/min/1.73 m2. The patients were grouped by initial eGFR decline: group 1 (<0%), group 2 (0%-10%), group 3 (10%-20%), and group 4 (≥20%), and subgrouped by the reduction in systolic blood pressure (SBP) (≥ or <10 mmHg). The risk of progression to an eGFR <15 mL/min/1.73 m2 was evaluated.

RESULTS

The mean initial eGFR decline was -2.6% ± 12.1% and SBP reduction was -7.9 ± 16.6 mmHg. During the 8-year follow-up, as the initial eGFR decline increased, the subsequent annual rate of eGFR decline increased (group 1, -0.87; group 2, -3.21; group 3, -5.38; group 4, -8.90, mL/min/1.73 m2/year). The adjusted hazard ratio increased with a greater initial eGFR decline (hazard ratio: 4.31 for group 4 vs group 1). This risk was accelerated if the reduction in SBP was <10 mmHg.

CONCLUSIONS

Assessing the initial eGFR decline and SBP reduction after starting an RAS inhibitor may predict long-term renal function.