title: Effects of the Renin-Angiotensin system blockade on hemoglobin levels in type 2 diabetic patients with chronic kidney disease.
abstract: 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 m(2), 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.
authors.affiliation: Division of Nephrology and Hypertension, Department of Medicine, Diabetes Center, Tokyo Women's Medical University School of Medicine, Tokyo, Japan.
authors.forename: Aiko
authors.initials: A
authors.lastname: Inoue
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Babazono
authors.forename: Yasuhiko
authors.initials: Y
authors.lastname: Iwamoto
mesh_terms: D018674:Adrenergic Antagonists / Q000494:pharmacology*; D000368:Aged; D000740:Anemia / Q000097:blood / Q000209:etiology; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000494:pharmacology; D002908:Chronic Disease; D015331:Cohort Studies; D003404:Creatinine / Q000097:blood; D003924:Diabetes Mellitus, Type 2 / Q000097:blood*; D003928:Diabetic Nephropathies / Q000097:blood* / Q000150:complications; D005260:Female; D005919:Glomerular Filtration Rate / Q000187:drug effects; D006454:Hemoglobins / Q000187:drug effects / Q000378:metabolism*; D006801:Humans; D007674:Kidney Diseases / Q000097:blood* / Q000150:complications; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012084:Renin-Angiotensin System / Q000187:drug effects*; D012189:Retrospective Studies; D012307:Risk Factors
chemical_list: D018674:Adrenergic Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D006454:Hemoglobins; D003404:Creatinine