(SLC-002) Comparison of Nephroprotective Effects Between Long- and Short-acting Angiotensin Receptor Blockers in Diabetic Nephropathy: A Real-world Retrospective Study

Background: Diabetic nephropathy (DN) is a major cause of end-stage kidney disease (ESKD), and slowing its progression in diabetic patients is critical. The variations in half-life of antiotensin receptor blockers (ARBs) may explain the differing nephroprotective effects among individual ARBs, which are recommended for patients with DN.

Objectives: To compare the long-term nephroprotective effects of long versus short half-life ARBs in people with DN, utilizing real-world clinical data.

Methods: This retrospective cohort study included patients aged 18 or older with type 2 diabetes and albuminuria who had been using ARBs with either long (≥6 hours) or short ( < 6 hours) half-lives for more than one year, based on electronic medical records from Seoul National University Hospital between January 2012 and December 2019. Propensity score matching (1:1, nearest neighbor, caliper = 0.2) ensured comparability between the users of long and short half-life ARBs. The primary outcome was a composite kidney event, defined as dialysis initiation, kidney transplantation, or a sustained 40% decline in eGFR from baseline. Multiple Imputation by Chained Equations (MICE) was used to address missing clinical data, while Kaplan-Meier and Cox proportional hazards models were applied for a survival analysis. Hazard ratios (HR) from each imputed dataset were pooled using the Rubin's rule. The Schoenfeld residual test was used to check the proportional hazards assumption. Sensitivity analysis was conducted on non-missing blood pressure data, which had a high missingness rate and was closely associated with the outcome.

Results: 768 patients were included in each group (total n = 1,536). Kaplan-Meier analysis showed no significant difference in the primary outcome between the users of long and short half-life ARBs (log-rank P = 0.593). Cox regression, adjusting for age, sex, hemoglobin A1c, baseline eGFR, albuminuria, number of antihypertensives, and diabetic retinopathy, showed no significant difference in the primary outcome (adjusted HR: 1.019; 95% confidence interval (CI): 0.795–1.307; P = 0.880). The proportional hazards assumption was met. Sensitivity analysis also showed no significant difference in the primary outcome.

Conclusions: This study found no significant difference in long-term nephroprotective effects between long and short half-life ARBs in people with DN. Further research utilizing diverse data sources is recommended to support individual ARB selection in clinical practice.