The following is a summary of “Use of maximal dosage renin-angiotensin-aldosterone system inhibitors in a real life population of complicated type 2 diabetes – contraindications and opportunities,” published in the August 2023 issue of Nephrology by Gant et al.

Inhibiting the renin-angiotensin-aldosterone-system (RAASi) is vital for treating hypertension, renoprotection, and cardiovascular disease prevention in type 2 diabetes patients, with dose-dependent effects. Researchers conducted a retrospective study for maximal dosage RAASi prevalence and contraindications for optimizing it in real-life clinical settings among patients with complex type 2 diabetes.

They analyzed 668 patients from the DIAbetes and LifEstyle Cohort Twente (DIALECT). Patients were grouped into no RAASi, submaximal RAASi, and maximal RAASi. Potassium and creatinine data from January 1st, 2000, to DIALECT inclusion from patient files. Identified factors influencing RAASi use via logistic regression.

The result showed 460 patients (69%) utilized RAASi, (30%) maximal RAASi, with an average age of 64 ± 10 years, (61%) being men. There is no significant variance in maximal RAASi usage across indications (e.g., hypertension, diabetic kidney disease) (P>0.05). Each patient had 2 [1-4] potassium measurements and 20 [13-31] creatinine measurements, with a pensive follow-up of -3.0 [-1.4 to -5.7] years. Before baseline, 151 (23%) patients had hyperkalemia (>5.0 mmol/l), and 119 (18%) had acute kidney injury. Factors influencing maximal RAASi utilization included previous acute kidney injury (OR 0.51 (0.30–0.87)), heightened albuminuria (OR 1.89 (1.17–3.08)), and the total count of employed antihypertensives (OR 1.66 (1.33–2.06)).

They concluded RAASi is worthwhile for maximizing RAASi in a real-life setting, despite contraindications, making it suitable for type 2 diabetes patients.

Source: bmcnephrol.biomedcentral.com/articles/10.1186/s12882-023-03205-2