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LetterCorrespondence
Open Access

Comment on: The current practice of using angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers in diabetic hypertensive and non-hypertensive patients. Is there a room for vitamin D?

Abdulghani Alsaeed
Saudi Medical Journal January 2021, 42 (1) 116; DOI: https://doi.org/10.15537/smj.2021.1.25621
Abdulghani Alsaeed
Endocrine and Diabetes Department Prince Sultan Military Medical City Riyadh, Kingdom of Saudi Arabia
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To the Editor

I have read with interest the article by Sukkarieh et al,1 about the current practice of angiotensin-converting enzyme inhibitors (ACEi) and angiotensin receptor blockers (ARB) in patients with diabetes mellitus with nephropathy whether they were suffering from hypertension or not? And if vitamin D supplement has room in the management of diabetic nephropathy or not? It’s noteworthy, that diabetic nephropathy is an old terminology used historically to indicate the presence of albuminuria in patients with type 1 diabetes mellitus and retinopathy.2 Currently, diabetic kidney disease has replaced diabetic nephropathy which includes conditions with persistent albuminuria, low Estimated glomerular filtration rate (eGFR), or any manifestations of kidney damage in patients with diabetes mellitus.3

Renin-angiotensin system (RAS) inhibition is considered the cornerstone part of the management of diabetic kidney disease. It has been shown the benefit of these drugs is beyond the blood pressure-lowering effect, as they also reduce proteinuria and slow the progression of kidney disease. Monitoring the renal function including creatinine and potassium level after starting the ACEi or ARB is recommended by different guidelines, however, it is not commonly implemented in the clinical practice either because of lacking the knowledge about its importance or working in a busy clinic with a long period of follow up.3,4 However, in this study by Sukkarieh et al,1 most of the participating physicians (70%) agreed about monitoring the renal function before and after starting ACEi or ARB. One additional important point mentioned in this study is the combination of RAS inhibition drugs. Although the literature emphasized the combination of both ACEi and ARB carries an increased risk of hyperkalemia, this cohort found the use of such a combination was as high as almost 30%.5

Vitamin D supplement is part of the management of patients who require renal replacement therapy due to chronic kidney disease. Is there strong evidence about the use of vitamin D in patients with diabetic kidney disease without renal impairment? There is uncertainty about the benefit of vitamin D supplements in patients with diabetic kidney disease and preserved renal function. In this study, almost 50% of the participating physicians did not think that vitamin D can help patients with diabetic nephropathy. Vitamin D deficiency is common in our community with a prevalence of 60% in one report.6 So, if someone tries to link it to any disease, it might give a positive relationship. However, it is not necessarily indicating the treatment with vitamin D would make a difference in management.

One of the major limitations of the study by Sukkarieh et al,1 that most of the participating physicians were internists or family medicine doctors while endocrinologists accounted for less than 10% and nephrologists for 6%. Such selection might not truly represent the exact physicians who deal with the problems related to diabetic kidney disease.

Finally, I would like to thank Sukkarieh and colleagues for their great study which illustrates the practice of using such important medications as ACEi and ARB in patients with diabetic kidney disease.

Reply from the Author

No reply was received from the Author.

  • Copyright: © Saudi Medical Journal

This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

References

  1. ↵
    1. Sukkarieh HH,
    2. Bustami RT,
    3. Abdu MN,
    4. Khokhar AA,
    5. Salih AA,
    6. Abdalla HK
    (2020) The current practice of using angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers in diabetic hypertensive and non-hypertensive patients. Is there a room for vitamin D? Saudi Med J 41:1083–1089.
    OpenUrlAbstract/FREE Full Text
  2. ↵
    1. Olivarius Nde F,
    2. Andreasen AH,
    3. Keiding N,
    4. Mogensen CE
    (1993) Epidemiology of renal involvement in newly-diagnosed middle-aged and elderly diabetic patients. Cross-sectional data from the population-based study “Diabetes care in general practice” Denmark Diabetologia 36:1007–1016.
    OpenUrl
  3. ↵
    1. Standard of medical care in diabetes- 2020
    (2020) Diabetes Care 43(Supplement 1):S1–S2.
    OpenUrlFREE Full Text
  4. ↵
    1. Ponikowski P,
    2. Voors AA,
    3. Anker SD,
    4. Bueno H,
    5. Cleland JGF,
    6. Coats AJS,
    7. et al.
    (2016) 2016 ESC guidelines for the diagnosis and treatment of acute and chronic heart failure:the task force for the diagnosis and treatment of acute and chronic heart failure of the European society of cardiology (ESC) developed with the special contribution of the heart failure association (HFA) of the ESC. Eur Heart J 37:2129–2200.
    OpenUrlCrossRefPubMed
  5. ↵
    1. Fried LF,
    2. Emanuele N,
    3. Zhang JH,
    4. Brophy M,
    5. Conner TA,
    6. Duckworth W,
    7. et al.
    (2013) Combined angiotensin inhibition for the treatment of diabetic nephropathy. N Engl J Med 369:1892–1903.
    OpenUrlCrossRefPubMed
  6. ↵
    1. AlFaris NA,
    2. AlKehayez NM,
    3. AlMushawah FI,
    4. AlNaeem AN,
    5. AlAmri ND,
    6. AlMudawah ES
    (2019) Vitamin D deficiency and associated risk factors in women from Riyadh Saudi Arabia. Sci Rep 9:20371.
    OpenUrl
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Saudi Medical Journal: 42 (1)
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Comment on: The current practice of using angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers in diabetic hypertensive and non-hypertensive patients. Is there a room for vitamin D?
Abdulghani Alsaeed
Saudi Medical Journal Jan 2021, 42 (1) 116; DOI: 10.15537/smj.2021.1.25621

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Comment on: The current practice of using angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers in diabetic hypertensive and non-hypertensive patients. Is there a room for vitamin D?
Abdulghani Alsaeed
Saudi Medical Journal Jan 2021, 42 (1) 116; DOI: 10.15537/smj.2021.1.25621
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© 2025 Saudi Medical Journal Saudi Medical Journal is copyright under the Berne Convention and the International Copyright Convention.  Saudi Medical Journal is an Open Access journal and articles published are distributed under the terms of the Creative Commons Attribution-NonCommercial License (CC BY-NC). Readers may copy, distribute, and display the work for non-commercial purposes with the proper citation of the original work. Electronic ISSN 1658-3175. Print ISSN 0379-5284.

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