Prescription of antihypertensive agents in the treatment of hypertension in diabetic nephropathy patients on hemodialysis
DOI:
https://doi.org/10.18203/2319-2003.ijbcp20211642Keywords:
Hypertension, Diabetic nephropathy, Chronic kidney disease, Maintenance hemodialysis, Antihypertensive medicationAbstract
Background: All the patients with diabetic nephropathy have inherent hypertension and uncontrolled hypertension leads to deterioration in the kidney disease speedily. Aims and objectives were to analyze the prescription of antihypertensive agents in the treatment of hypertension in diabetic nephropathy patients on hemodialysis.
Methods: The study was conducted on diabetic nephropathy patients on maintenance hemodialysis, in Sri Aurobindo Institute of Medical Sciences, Indore (M.P.). We had included 73 diabetic nephropathy patients on maintenance hemodialysis, who provided their consent for participation in the study. Pearson coefficient of correlation was used for finding the correlation. Unpaired ‘t’ test was applied for intergroup mean comparison. A p value of<0.05 was taken as statistically significant.
Results: Total 73 diabetic nephropathy patients were included, with 80.8% being males. Mean age was 57.74±8.44 years. Mean duration of dialysis was 32.06±35.84 months. Calcium channel blockers was given in 91.8% patients, followed by beta blockers in 61.6%. Other antihypertensives used had lower prevalence. 65.8% patients required combination of 1-3 antihypertensives, 24.7% required 4-5 antihypertensives for control of hypertension. The mean number of antihypertensive medications was comparable between the two genders (p>0.05). An inverse and statistically not significant correlation was seen between duration of dialysis; age and use of multiple antihypertensive medications (p>0.05).
Conclusions: A strong association has been reported by many between hypertension and diabetic nephropathy. It is imperative that hypertension is well controlled in all the patients of diabetic nephropathy. This will slow down the progression of kidney disease and improve the quality of life in patients with diabetic nephropathy.
Metrics
References
Ritz E, Zeng X. Diabetic nephropathy - Epidemiology in Asia and the current state of treatment. Indian J Nephrol. 2011;21(2):75-84.
Frank LL. Diabetes mellitus in the texts of old Hindu medicine (Charaka, Susruta, Vagbhata). Am J Gastroenterol. 1957;27(1):76-95.
Elflein J. Number of people with diabetes, by country 2019. Available at: https://www.statista.com/statistics/281082/countries-with-highest-number-of-diabetics/#:~:text=Number%20of%20people%20with%20diabetes%2C%20by%20country%202019&text=China%20is%20the%20country%20with,134%20million%20people%20with%20diabetes. Accessed on 15 August 2020.
Mohan V, Sandeep S, Deepa R, Shah B, Varghese C. Epidemiology of type 2 diabetes: Indian scenario. Indian J Med Res. 2007;125(3):217-30.
Pradeepa R, Anjana RM, Unnikrishnan R, Ganesan A, Mohan V, Rema M. Risk factors for microvascular complications of diabetes among South Indian subjects with type 2 diabetes--the Chennai Urban Rural Epidemiology Study (CURES) Eye Study-5. Diabetes Technol Ther. 2010;12(10):755-61.
Modi GK, Jha V. The incidence of end-stage renal disease in India: a population-based study. Kidney Int. 2006;70(12):2131-3.
Prakash J, Hota JK, Singh S, Sharma OP. Clinical spectrum of chronic renal failure in the elderly: a hospital based study from eastern India. Int Urol Nephrol. 2006;38(3-4):821-7.
Agarwal SK, Srivastava RK. Chronic kidney disease in India: challenges and solutions. Nephron Clin Pract. 2009;111(3):c197-203.
Van Buren PN, Toto R. Hypertension in diabetic nephropathy: epidemiology, mechanisms, and management. Adv Chronic Kidney Dis. 2011;18(1):28-41.
KDOQI. KDOQI Clinical Practice Guidelines and Clinical Practice Recommendations for Diabetes and Chronic Kidney Disease. Am J Kidney Dis. 2007;49(2 Suppl 2):S12-154.
James PA, Oparil S, Carter BL, Eighth Joint National Committee (JNC 8) Members et al. 2014 evidence-based guideline for the management of high blood pressure in adults: report from the panel members appointed to the Eighth Joint National Committee (JNC 8), Supplemental Content. JAMA. 2014;311:507-20.
Diabetic nephropathy. Available at: https://www.mydr.com.au/diabetes/diabetic-nephropathy#:~:text=Diabetic%20nephropathy%20(diabetic%20kidney%20disease,lets%20protein%20into%20your%20urine. Accessed on 15 August 2020.
Ismail N, Becker B, Strzelczyk P, Ritz E. Renal disease and hypertension in non-insulin-dependent diabetes mellitus. Kidney Int. 1999;55(1):1-28.
Bakris GL, Williams M, Dworkin L, Elliott WJ, Epstein M, Toto R, et al. Preserving renal function in adults with hypertension and diabetes: a consensus approach. National Kidney Foundation Hypertension and Diabetes Executive Committees Working Group. Am J Kidney Dis. 2000;36(3):646-61.
Joseph N, Yogananda R, Bharathi DR, Padman V, Sandeep GN. A study on prescription pattern of antihypertensive agents in chronic renal failure patients and assessment of medication adherence. Int J Pharm Sci Rev Res. 2017;45(2):72-5.
Saju AP, Edakkarayil AC, Maheswari E, Gurudev KC. Prescribing pattern and cost effectiveness analysis of antihypertensive drugs in chronic kidney disease patients. EJPMR. 2016;3(1):219-25.
Kasiske BL, Kalil RS, Ma JZ, Liao M, Keane WF: Effect of antihypertensive therapy on the kidney in patients with diabetes: a meta-regression analysis. Ann Intern Med. 1993;118:129-38.
Downloads
Published
How to Cite
Issue
Section
