Common BP drugs linked to worse kidney outcomes in diabetic kidney disease

Clinical Takeaway: In patients with type 2 diabetes receiving both RAS inhibitors and SGLT2 inhibitors, DCCB use was associated with a significantly higher risk of CKD progression. While causality hasn’t been established, clinicians may wish to carefully evaluate antihypertensive selection in patients with diabetic kidney disease pending further study.

Dihydropyridine calcium-channel blockers (DCCBs) are widely used as second-line antihypertensive agents in diabetic kidney disease; these findings raise questions about their kidney safety in patients already receiving contemporary renoprotective therapies.

A large observational study presented at ERA Congress 2026 suggests that DCCBs may be associated with worse kidney outcomes in patients with type 2 diabetes and diabetic kidney disease (DKD), even when used alongside guideline-directed kidney-protective therapies.

Investigators analyzed data from 31,031 adults with type 2 diabetes treated between 2016 and 2021. All participants were receiving both a renin-angiotensin system (RAS) inhibitor and an SGLT2 inhibitor. Among them, 12,172 patients (39.2%) were taking a DCCB, while 18,859 received other antihypertensive medications. Median follow-up was approximately 3.5 years.

After adjustment for baseline demographic and clinical differences, DCCB use was associated with a 33% higher risk of major adverse kidney events versus other antihypertensive therapies (risk ratio, 1.33; 95% confidence interval, 1.03-1.73). The composite outcome included a sustained decline in eGFR of at least 40% or progression to end-stage kidney disease requiring dialysis or transplantation.

“DCCBs are widely used as second-line blood pressure treatments in patients with DKD,” said lead author Dr Timna Agur. “Our findings raise important questions about whether these medications are always the best option for patients already receiving modern kidney-protective therapies.”

Researchers hypothesized that DCCBs may increase pressure within the kidney’s filtering units, potentially contributing to ongoing damage. However, the authors emphasized that the study was observational and cannot prove causation. Prospective studies and randomized trials are needed to determine whether the association reflects a true treatment effect and to clarify optimal blood pressure management strategies in DKD.

Source: Agur T, et al. DCCB therapy and risk of CKD progression in type 2 diabetes on RASi and SGLT2i. Presented at the 63rd European Renal Association (ERA) Congress; 2026; Glasgow, Scotland.