Background

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.

Methods

Diabetic patients with an estimated glomerular filtration rate (eGFR) <60 ml/min/1.73 m², 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.

Results

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).

Conclusions

Treatment with an ARB, but not ACEI, may be associated with a modest decrease in hemoglobin levels in diabetic patients with CKD.

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