title: Effect of angiotensin converting enzyme inhibitor on glomerular hyperfiltration in patients with type 1 diabetes.
abstract: OBJECTIVE
  To assess the effect of angiotensin converting enzyme inhibition on glomerular filtration rate (GFR) in normotensive patient with type 1 diabetes.
  
  
  METHODS
  A two year non-placebo control prospective study was conducted after ethical approval at Diabetes Centre of Diabetic Association of Pakistan, a WHO collaborating centre in Karachi, Pakistan. All patients with type 1 diabetes visited the out-patients department from August 2009 till July 2011 and those who fulfilled the inclusion criteria were invited to participate. A total of 121 people aged ≥18 years and ≥ 5 years of diabetes were included. Pregnant and lactating woman and those aged <18 years were excluded. GFR was calculated by using CKD-EPI formula (eGFR) at baseline and after two year. On the basis of estimated GFR, patients at baseline were divided according to KDIGO classification of chronic kidney diseases into, hyperfiltration (eGFR ≥ 100 ml/min) and normal filtration group (eGFR < 100 ml/min). All subjects in hyperfiltration group received ACE inhibitor (treatment group) while patients with normal filtration did not receive ACE inhibitor (control group).
  
  
  RESULTS
  Fifty two patients (43%) were in the treatment and sixty nine (57%) were in the control group. At baseline eGFR, systolic and diastolic blood pressures between groups were non-significantly different. After two years, compared to baseline, eGFR of the treatment group declined and the control group increased significantly. No significant difference in systolic while diastolic blood pressure of the treatment group increased significantly after two years compared to baseline. In contrast both systolic and diastolic blood pressure of control group increased significantly after two years compared to their baseline values.
  
  
  CONCLUSIONS
  Present study demonstrated that initiation of ACEI in hyperfiltration stage declined GFR and keep blood pressure within normal range.
authors.affiliation: S. A. Jaffar Naqvi, Chief Executive, The Kidney Foundation, Karachi, Pakistan.
authors.forename: S A Jaffar
authors.initials: SA
authors.lastname: Naqvi
authors.affiliation: Shahid Ahsan, MBBS, MPhil (Biochemistry), MPhil (NCD). Associate Professor, Dept. of Biochemistry, Hamdard College of Medicine and Dentistry, Hamdard University, Karachi, Pakistan.
authors.forename: Shahid
authors.initials: S
authors.lastname: Ahsan
authors.affiliation: Asher Fawwad, PhD. Associate Professor, Baqai Medical University, Senior Research Scientist, Research Department, Baqai Institute of Diabetology and Endocrinology, Karachi, Pakistan.
authors.forename: Asher
authors.initials: A
authors.lastname: Fawwad
authors.affiliation: Abdul Basit, FRCP. Professor of Medicine, Department of Medicine Baqai Institute of Diabetology and Endocrinology, Baqai Medical University, Karachi, Pakistan.
authors.forename: Abdul
authors.initials: A
authors.lastname: Basit
authors.affiliation: A Samad Shera, FRCP. Honorary President (IDF), Secretary General (DAP), Director WHO Collaborating Centre, Diabetic Association of Pakistan, 5-E / 3, Nazimabad, Karachi-74600, Pakistan.
authors.forename: A Samad
authors.initials: AS
authors.lastname: Shera
keywords: Angiotensin converting enzyme inhibitor; Glomerular hyperfiltration; Type 1 diabetes