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The Role of ACE Inhibitors and Angiotensin Receptor Blockers in Diabetic Kidney Disease

Diabetic kidney disease (DKD) is a common symptom of type 1 and type 2 diabetes. It often leads to chronic kidney disease (CKD) and end-stage renal disease. One of the most essential parts of treating DKD is keeping the blood pressure under tight control. Some antihypertensive drugs also protect the kidneys in addition to dropping blood pressure. ACE inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) are two of these that are very important.

The Way ACE Inhibitors and ARBs Work

ACEIs and ARBs affect the renin-angiotensin-aldosterone system (RAAS). This hormone system controls blood pressure and fluid balance. People with diabetes are more likely to get kidney disease, as this system works too much. ARBs (like losartan and valsartan) block the receptors that angiotensin II binds to, while ACEIs (like lisinopril and enalapril) stop the enzyme that makes angiotensin II, a potent vasoconstrictor.

Clinical Evidence:

ACEIs and ARBs have been shown to work in many clinical studies to slow the progression of DKD. The benefits include:

  • Decreased proteinuria.

  • A sign of damaged kidneys.

  • A delay in developing end-stage kidney disease.

Importantly, using these medicines has been linked to helping the heart, which is important because people with DKD have a high chance of developing heart problems.

Current Recommendations:

As suggestions from groups like the American Diabetes Association and Kidney Disease: Improving Global Outcomes suggest, people with diabetes, high blood pressure, and albuminuria (more albumin in the urine, a sign of kidney damage) should use an ACEI or an ARB. This advice is usually the same, no matter how much albumin is in the urine or how high the GFR is, which measures how well the kidneys work.

Even though both ACEIs and ARBs can be helpful, they shouldn't be used together because they could cause harmful side effects like high blood potassium levels and sudden kidney function declines. Monitoring your kidney health and potassium levels is crucial when taking these medicines.


ACEIs and ARBs are still an essential part of the treatment arsenal for DKD because they protect both the kidneys and the heart. But they need to be used carefully and regularly checked for possible side effects. To get the best results, it is just as important to teach patients how important it is to take their medications as prescribed and change their lifestyles.

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