Effect of Ramipril Treatment on Proteinuria and Advanced Glycation End Products in Type 2 Diabetes Mellitus Patients with Nephropathy: One Year Follow up Study

Abstract

Aims: The present study was carried out to evaluate the effect of angiotensin converting enzyme inhibitor (ACEI) therapy on proteinuria and serum advanced glycation end products (AGEs) level in type 2 diabetes mellitus (T2DM) patients with nephropathy. Study Design: Single-arm prospective longitudinal study. Duration and Place of Study: The study subjects were enrolled from Diabetic and Nephrology clinic at University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi, India, between September 2013 and July 2014. Methodology: The study subjects comprised of clinically diagnosed T2DM patients (n = 75) with evidence of persistent micro-albuminuria (ACR; 30-299 mg/g creatinine) or overt albuminuria (ACR; ≥300 mg/g creatinine) tested on two separate occasions. These patients were treated with ACE inhibitor; ramipril (5 mg to 20 mg /day) for 12 months. Effectiveness was assessed based on change in urinary albumin/creatinine ratio (ACR) and serum AGEs level. Results: Ramipril treatment produced significant fall in log urinary ACR (P<0.001) and significant reduction in serum AGEs level (P<0.001) during 12 months follow up period as compared to baseline values. Also significant positive correlation between serum AGEs level and urinary ACR was observed at baseline. However, after one year follow up the serum AGEs level and urinary ACR did not correlate significantly. No significant change in serum creatinine and estimated glomerular filtration rate (eGFR) were observed after one year follow up. Conclusions: Apart from antiproteinuric action, ramipril treatment has been found to lower serum AGEs level that may eventually arrest vascular complications in T2DM patients with nephropathy.