Anemia due to Coadministration of Renin-Angiotensin-System Inhibitors and PPARγ Agonists in Uncomplicated Diabetic Patients

A. E. Raptis; D. Bacharaki; M. Mazioti; K. P. Marathias; K. P. Markakis; S. A. Raptis; G. D. Dimitriadis; D. V. Vlahakos

doi:10.1055/s-0032-1306286

Experimental and Clinical Endocrinology & Diabetes, Table of Contents

Exp Clin Endocrinol Diabetes 2012; 120(07): 416-419
DOI: 10.1055/s-0032-1306286

Article

Anemia due to Coadministration of Renin-Angiotensin-System Inhibitors and PPARγ Agonists in Uncomplicated Diabetic Patients

A. E. Raptis

¹2nd Department of Internal Medicine-Propaedeutic, Research Institute and Diabetes Centre, Athens University Medical School, Attikon University Hospital, Haidari, Greece

,

D. Bacharaki

¹2nd Department of Internal Medicine-Propaedeutic, Research Institute and Diabetes Centre, Athens University Medical School, Attikon University Hospital, Haidari, Greece

,

M. Mazioti

¹2nd Department of Internal Medicine-Propaedeutic, Research Institute and Diabetes Centre, Athens University Medical School, Attikon University Hospital, Haidari, Greece

,

K. P. Marathias

²Onassis Cardiac Surgery Center, Athens, Greece

,

K. P. Markakis

¹2nd Department of Internal Medicine-Propaedeutic, Research Institute and Diabetes Centre, Athens University Medical School, Attikon University Hospital, Haidari, Greece

,

S. A. Raptis

¹2nd Department of Internal Medicine-Propaedeutic, Research Institute and Diabetes Centre, Athens University Medical School, Attikon University Hospital, Haidari, Greece

³Hellenic National Center for Research, Prevention and Treatment of Diabetes Mellitus and its Complications (H.N.D.C.), Athens, Greece

,

G. D. Dimitriadis

¹2nd Department of Internal Medicine-Propaedeutic, Research Institute and Diabetes Centre, Athens University Medical School, Attikon University Hospital, Haidari, Greece

,

D. V. Vlahakos

¹2nd Department of Internal Medicine-Propaedeutic, Research Institute and Diabetes Centre, Athens University Medical School, Attikon University Hospital, Haidari, Greece

› Author Affiliations

Abstract

Aims:

Therapy with either angiotensin converting enzyme inhibitors and angiotensin receptor blockers (ACEI/ARB) or thiazolidinediones (TZD) is associated with dose-dependent decrements in hematocrit and hemoglobin levels. We aimed to investigate the impact of the coadministration of TZD and ACEI/ARB on hematocrit and hemoglobin values in uncomplicated patients with type 2 diabetes mellitus and normal serum creatinine.

Methods:

Data from patients with type 2 diabetes currently followed, were reviewed and patients treated with ACEI/ARB and/or TZD were identified. For the purpose of this study the following 4 groups of 30 stable non-anemic diabetic patients each matched for age, gender, and BMI were formed. Group ACEI/ARB included patients on ACEI/ARB without TZD, group TZD included patients on TZD and antihypertensive agents other than ACEI/ARB, group ACEI/ARB/TZD consisted of patients on combined therapy with ACEI/ARB and TZD and the control group C included patients never exposed to ACEI/ARB or TZD. Clinical and laboratory data were collected prior to initiation of treatment and after 6 months.

Results:

Neither hematocrit nor hemoglobin showed any significant change from baseline at the end of the study in group C. In both group ACEI/ARB and group TZD a small, but statistically significant reduction in hematocrit (~ 1% point) and hemoglobin levels (~ 0.3 g/dl) was seen. A greater statistically and clinically important reduction in hematocrit (~ 3% points) and hemoglobin (~ 1 g/dl) levels was observed in group ACEI/ARB/TZD. Furthermore, incident anemia at the end reached 7% in group TZD and 23% in group ACEI/ARB/TZD.

Conclusions:

Coadministration of RAS inhibitors and PPAR-γ agonists should be considered in the differential diagnosis of hematocrit lowering and anemia in uncomplicated type 2 diabetic patients with normal serum creatinine. Further studies are required to clarify the mechanism(s), the cardiovascular consequences and the cost utility of anemia workup in such patients.

Key words

diabetes - hypertension - cardiovascular incidences

Full Text

References

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