Assessing ACEI and ARB utilization in Karachi's diabetic nephropathy patients

Background: Diabetes mellitus (DM) is a major global health concern, and its microvascular complication, diabetic nephropathy, is a leading cause of chronic kidney disease and end-stage renal disease. Angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) are proven to delay the progression of diabetic nephropathy; however, their utilization patterns in Karachi, Pakistan, have not been adequately studied. Objectives: To assess the prevalence of ACEI and ARB use among patients with diabetic nephropathy in Karachi and to identify demographic and clinical factors influencing their utilization. Methods: A cross-sectional study was conducted at Aga Khan University Hospital, Karachi, from September 2021 to August 2022. A total of 118 patients diagnosed with diabetic nephropathy were recruited. Data on demographics, ACEI/ARB usage, creatinine levels, history of ischemic heart disease, and type of treating physician (endocrinologist vs. general physician) were collected. Patients were stratified by age, gender, and ischemic heart disease status. Statistical analysis was performed using chi-square tests, with significance set at p < 0.05. Results: Of the 118 patients, 53.4% were male and 46.6% female, with a mean age of 62.01 years. Coronary artery disease was present in 66.9% of the cohort. Only 9.3% of patients were under endocrinologist care, and all were prescribed ACEIs. Overall, just 26.3% of patients were receiving ACEIs or ARBs. Females had a slightly higher treatment rate than males (30.9% vs. 22.2%). Patients older than 65 years showed the highest ACEI/ARB utilization (41.9%), indicating an age-associated trend in prescribing patterns. Conclusion: The study reveals a substantial underuse of ACEIs and ARBs among diabetic nephropathy patients in Karachi, despite strong evidence supporting their effectiveness. This gap between clinical guidelines and real-world prescribing practices highlights the need for improved physician awareness, enhanced patient education, and strengthened healthcare systems. Addressing these factors could significantly improve renal outcomes and reduce the long-term burden of diabetic kidney disease in South Asia.