OBJECTIVES

: Randomised controlled trials showed that renin–angiotensin–aldosterone system (RAAS) inhibitors were beneficial for renal function, especially in high dosages or when renal function was reduced. The effect of RAAS inhibitors on renal function among patients with a normal renal clearance is less clear. In type 2 diabetes mellitus (T2DM) patients, who are at risk for renal damage, adherence to RAAS inhibitors is important. The objective was to determine if a higher adherence to RAAS inhibitors is associated with improved renal function among T2DM patients using real world data.

METHODS

: A cohort study was conducted using data from the PHARMO Database Network between 1999-2015. New users of RAAS inhibitors with T2DM in the Out-patient Pharmacy Database and availability of estimated glomerular filtration rate (eGFR) values in the Clinical Laboratory Database were selected. Adherence was determined by the medication possession ratio (MPR) and as persistence during a period of 15 months after initiating RAAS inhibitors (index date). To assess the association between renal function over time and adherence to RAAS inhibitors, mixed-effect model repeated measures were performed (adjusted for age, gender, number of eGFR measurements and chronic disease score) by modelling eGFR over time, separately for patients with low (<80%) and high (≥80%) MPR; and for those with long (≥6 months) and short (<6 months) persistence.

RESULTS

: Overall, 8,950 patients were included (57% male, mean ± SD age at index date 66 ± 11 years); of which 74% with a high MPR and 84% with a long persistence. During the 15 months after index date, mean eGFR declined about 2.5 ml/min/1.73m² in patients with a low adherence; and about 4 ml/min/1.73m for patients with a high adherence.

CONCLUSIONS

: A higher adherence to RAAS inhibitors was not associated with improved renal function among T2DM patients, using real world data.