End-stage renal disease and adherence to angiotensin-converting enzyme inhibitors and angiotensin receptor blockers among patients with diabetes.
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.
Family Medicine Department, Central District, Clalit Health Service, Mazkeret Batya, Israel.|Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel.
Michal
M
Shani
Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel.
Shlomo
S
Vinker
Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel.|Nephrology Department, Assaf Harofeh Medical Center, Zerifin, Israel.
Leonid
L
Feldman
D000368:Aged; D057911:Angiotensin Receptor Antagonists / Q000627:therapeutic use*; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use*; D003920:Diabetes Mellitus / Q000175:diagnosis / Q000188:drug therapy; D003928:Diabetic Nephropathies / Q000150:complications / Q000188:drug therapy*; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000188:drug therapy; D007557:Israel / Q000453:epidemiology; D007676:Kidney Failure, Chronic / Q000150:complications / Q000188:drug therapy* / Q000517:prevention & control; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome; D016903:Drug Monitoring
D057911:Angiotensin Receptor Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors