Chronic Kidney Disease Progression Risk in Patients With Diabetes Mellitus Using Dihydropyridine Calcium Channel Blockers: A Nationwide, Population-Based, Propensity Score Matching Cohort Study.

Shih-Yi Lin,Chia-Hung Kao,Chung-Y Hsu,Wu-Huei Hsu,Cheng-Chieh Lin,Cheng-Li Lin

doi:10.3389/fphar.2022.786203

Abstract

Background: Whether diabetes mellitus (DM) patients with chronic kidney disease (CKD) can glean individual renal benefit from dihydropyridine calcium channel blockers (DCCBs) remains to be determined. We conducted a nationwide, population-based, propensity score matching cohort study to examine the effect of DCCBs on CKD progression in DM patients with CKD. Methods: One million individuals were randomly sampled from Taiwan’s National Health Insurance Research Database. The study cohort consisted of DM patients with CKD who used DCCBs. The comparison cohort was propensity-matched for demographic characteristics and comorbidities. The endpoint was advanced CKD or end-stage renal disease (ESRD). The Cox proportional hazards model was used to calculate the risks. Results: In total, 9,761 DCCB users were compared with DCCB nonusers at a ratio of 1:1. DCCB users had lower risk of advanced CKD and ESRD than nonusers—with adjusted hazard ratio [aHR; 95% confidence interval (CI)] of 0.64 (0.53–0.78) and 0.59 (95% CI, 0.50–0.71) for advanced CKD and ESRD, respectively. DCCB users aged ≥65 years had the lowest incidence rates of advanced CKD and ESRD—with aHR (95% CI) of 0.47 (0.34–0.65) and 0.48 (0.35–0.65) for advanced CKD and ESRD, respectively. Finally, cumulative DCCB use for >1,100 days was associated with the lowest advanced CKD and ESRD risks [(aHR, 0.29 (95% CI, 0.19–0.44)]. Conclusion: DM patients with CKD who used DCCBs had lower risk of progression to advanced CKD and ESRD than nonusers did.

Highlights

Dihydropyridine calcium channel blockers (DCCBs), which bind to calcium channels located on vascular smooth muscles to interrupt calcium entry, are widely used in clinical practice to reduce blood pressure (Braunwald, 1982; Eisenberg et al, 2004)
dihydropyridine calcium channel blockers (DCCBs) users had lower risk of advanced chronic kidney disease (CKD) and end-stage renal disease (ESRD) than nonusers—with adjusted hazard ratio [aHR; 95% confidence interval (CI)] of 0.64 (0.53–0.78) and 0.59 for advanced CKD and ESRD, respectively
Whether DCCBs have individual benefits or harms on kidney function, in diabetes mellitus (DM) patients with chronic kidney disease (CKD), who are at the highest risk for end-stage renal disease (ESRD), remains unclear

Summary

Introduction

Dihydropyridine calcium channel blockers (DCCBs), which bind to calcium channels located on vascular smooth muscles to interrupt calcium entry, are widely used in clinical practice to reduce blood pressure (Braunwald, 1982; Eisenberg et al, 2004). Whether DCCBs have individual benefits or harms on kidney function, in diabetes mellitus (DM) patients with chronic kidney disease (CKD), who are at the highest risk for end-stage renal disease (ESRD), remains unclear (de Leeuw et al, 2004). This is partly because CKD and CV events share multiple risk factors and medications (Cai et al, 2013) and the other part due to intrinsic characteristic of DCCBs of vasodilatation of afferent arterioles and increased intraglomerular pressure (Carmines and Navar, 1989; Kimura et al, 1994). Population-based, propensity score matching cohort study to examine the effect of DCCBs on CKD progression in DM patients with CKD

Methods

Results

Conclusion