Prevention of new-onset chronic kidney disease with renin-angiotensin system blockers in type 2 diabetes with preserved kidney function
In brief
ACE inhibitors or ARBs lower new-onset CKD risk by ~28% in diabetics
In a retrospective cohort of over 4,700 adults with type 2 diabetes, newly diagnosed hypertension and normal kidney function, use of an ACEI or ARB reduced the chance of developing chronic kidney disease by roughly one-quarter compared with no therapy. The benefit persisted after adjusting for competing risks and varying drug exposure, suggesting early renal protection, though prospective trials are needed.
- Journal
- Renal failure (Q1)
- Published
- 5 August 2026
- Study design
- Retrospective cohort
- Evidence level
- Level 3, Low (CEBM 3b)
- Authors
- Wan-Chia Hsu, Shih-Yuan Hung, Sheng-Hsiang Lin, Yuan-Yow Chiou, Yu-Ling Lin, Hsi-Hao Wang, et al.
- PMID
- 42552947
- DOI
- 10.1080/0886022X.2026.2711459
Why clinicians should know about it
- Picked for Critical Care and Intensive Care Medicine (paper of the day, 6 August 2026): Retrospective cohort, RAS blockers prevent CKD
Abstract
Renin-angiotensin system (RAS) blockers, including angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs), are known to slow chronic kidney disease (CKD) progression in patients with established renal impairment. However, whether RAS blockade can prevent new-onset CKD in patients with type 2 diabetes and hypertension who maintain preserved kidney function remains unclear. We addressed this question in a multicenter retrospective cohort study. Beginning with 316,693 individuals with type 2 diabetes and newly diagnosed hypertension, we retained 3,316 ACEI/ARB users and 1,409 nonusers after generalized boosted model weighting to equalize baseline characteristics. Three renal endpoints were followed: a sustained eGFR below 60 mL/min/1.73 m2, incident albuminuria (urinary albumin-to-creatinine ratio of 30 mg/g or higher), and a composite of either. Associations between RAS blocker exposure and each endpoint were quantified using Cox proportional hazards regression, with competing-risk and time-dependent variants applied as confirmatory analyses. ACEI/ARB therapy was associated with a significantly lower risk of new-onset CKD (HR 0.72; 95% CI 0.60-0.86), with consistent findings after accounting for competing risks (HR 0.73; 95% CI 0.61-0.87) and time-dependent exposure (HR 0.81; 95% CI 0.68-0.96). These findings suggest that RAS blockade may confer early kidney protection in patients with type 2 diabetes and hypertension with preserved renal function.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.