Renin-Angiotensin System (RAS) Inhibitors in High-Risk Patients With Type 2 Diabetes and Cardio-Renal Risk.
5 affiliations
- 1Department of Nephrology, King's College Hospital London, Dubai, ARE.
- 2Department of Endocrinology, Imperial College London Diabetes Centre, Abu Dhabi, ARE.
- 3Faculty of Medicine, Pavol Jozef Šafárik University, Košice, SVK.
- 4Faculty of Medicine, Andrzej Frycz Modrzewski Krakow University, Krakow, POL.
- 5Department of Emergency Medicine, University College London Hospitals NHS Foundation Trust, London, GBR.
Abstract
Background
Renin-angiotensin system inhibitors (RASi) are recommended as first-line therapy for patients with type 2 diabetes (T2D) and chronic kidney disease (CKD), particularly in the presence of hypertension or albuminuria. This study assessed the treatment patterns in a cohort of high-risk T2D patients.Methods
This cross-sectional, retrospective study included 33,524 adults with T2D from the Imperial College London Diabetes Centre (United Arab Emirates). Demographic, clinical, and laboratory parameters (estimated glomerular filtration rate, urine albumin-to-creatinine ratio, and blood pressure (BP)), and medication usage were analysed. The primary outcome was the analysis of treatment patterns in patients undergoing RASi; secondary outcomes included prescribing trends in CKD risk categories and among hypertensive and albuminuric subgroups.Results
Among 33,524 patients with T2D, mean age was 59.2 years, BMI 29.4 kg/m², and 67.1% (n=22,508) of the patients were classified as KDIGO (Kidney Disease: Improving Global Outcomes) G1 and 73.3% (n=24,580) as A1 albuminuria. Overall, 35.3% (n=13,705) received RASi, while 64.7% (n=25,128) were treated with alternative therapies including SGLT2 inhibitors, GLP-1 receptor agonists, or finerenone. Among patients with albuminuria >3.5 mg/mmol, only 62% (n=4944) were prescribed RASi, despite meeting clear indications for treatment. In KDIGO-based risk stratification, only 39% (n=4406) of patients in the high and very high CKD progression risk categories were on RASi. Among the hypertensive subgroup (n=4,824; defined as BP >130/80 mmHg), 48.96% (n=2,362) were prescribed RASi, leaving over 50% of patients untreated with this guideline-recommended therapy. Furthermore, 7.46% (n=2,462) of the entire cohort had hypertension but were not receiving RASi. This gap was more prominent among those with coexisting albuminuria or CKD. These findings reflect under-treatment even among those at greatest risk of renal and cardiovascular events.Conclusion
In patients with T2D and established renal or cardiovascular risk, treatment patterns remain variable in real-world practice. Less than half of hypertensive or albuminuric patients received RASi, highlighting a significant implementation gap. Addressing barriers to RASi prescription is essential to align real-world clinical practice with international guidelines and improve patient outcomes.
Related
- Renin-angiotensin system inhibitors initiation and mortality in non-proteinuric chronic kidney disease: a target trial emulation
- Serum Osteopontin Is Associated with Cardio-Ankle Vascular Index-Defined Arterial Stiffness in Patients with Type 2 Diabetes Mellitus: A Cross-Sectional Study
- A physiology-based mathematical model of the renin-angiotensin system, bone remodeling, and calcium homeostasis: Effects of estrogen and renin-angiotensin system inhibitors
- Renoprotective vs. Antihypertensive Dosing of Renin–Angiotensin System Inhibitors in Chronic Kidney Disease: Analysis of Summary of Product Characteristics of Medicinal Products Authorized in Poland
- Impact of renin-angiotensin system inhibitors discontinuation in advanced chronic kidney disease: a target trial emulation
BibTeX
@article{ahmed2026reninangiotensin,
title = {{Renin-Angiotensin System (RAS) Inhibitors in High-Risk Patients With Type 2 Diabetes and Cardio-Renal Risk.}},
author = {Mustafa J Ahmed and Aftab M Ahmad and Saf Naqvi and Khalid Ahmed and Aisha Ahmed and Zainab Naqvi},
journal = {Cureus},
year = {2026},
month = sep,
doi = {10.7759/cureus.116699},
url = {https://europepmc.org/article/MED/42923248},
note = {CC BY},
}
RIS
TY - JOUR
TI - Renin-Angiotensin System (RAS) Inhibitors in High-Risk Patients With Type 2 Diabetes and Cardio-Renal Risk.
AU - Mustafa J Ahmed
AU - Aftab M Ahmad
AU - Saf Naqvi
AU - Khalid Ahmed
AU - Aisha Ahmed
AU - Zainab Naqvi
PY - 2026
DA - 2026/09/22
JO - Cureus
DO - 10.7759/cureus.116699
UR - https://europepmc.org/article/MED/42923248
AB - Background Renin-angiotensin system inhibitors (RASi) are recommended as first-line therapy for patients with type 2 diabetes (T2D) and chronic kidney disease (CKD), particularly in the presence of hypertension or albuminuria. This study assessed the treatment patterns in a cohort of high-risk T2D patients.Methods This cross-sectional, retrospective study included 33,524 adults with T2D from the Imperial College London Diabetes Centre (United Arab Emirates). Demographic, clinical, and laboratory parameters (estimated glomerular filtration rate, urine albumin-to-creatinine ratio, and blood pressure (BP)), and medication usage were analysed. The primary outcome was the analysis of treatment patterns in patients undergoing RASi; secondary outcomes included prescribing trends in CKD risk categories and among hypertensive and albuminuric subgroups.Results Among 33,524 patients with T2D, mean age was 59.2 years, BMI 29.4 kg/m², and 67.1% (n=22,508) of the patients were classified as KDIGO (Kidney Disease: Improving Global Outcomes) G1 and 73.3% (n=24,580) as A1 albuminuria. Overall, 35.3% (n=13,705) received RASi, while 64.7% (n=25,128) were treated with alternative therapies including SGLT2 inhibitors, GLP-1 receptor agonists, or finerenone. Among patients with albuminuria >3.5 mg/mmol, only 62% (n=4944) were prescribed RASi, despite meeting clear indications for treatment. In KDIGO-based risk stratification, only 39% (n=4406) of patients in the high and very high CKD progression risk categories were on RASi. Among the hypertensive subgroup (n=4,824; defined as BP >130/80 mmHg), 48.96% (n=2,362) were prescribed RASi, leaving over 50% of patients untreated with this guideline-recommended therapy. Furthermore, 7.46% (n=2,462) of the entire cohort had hypertension but were not receiving RASi. This gap was more prominent among those with coexisting albuminuria or CKD. These findings reflect under-treatment even among those at greatest risk of renal and cardiovascular events.Conclusion In patients with T2D and established renal or cardiovascular risk, treatment patterns remain variable in real-world practice. Less than half of hypertensive or albuminuric patients received RASi, highlighting a significant implementation gap. Addressing barriers to RASi prescription is essential to align real-world clinical practice with international guidelines and improve patient outcomes.
SN - 2168-8184
ER -