The use of dihydropyridine calcium-channel blockers (DCCBs) may be associated with worse renal outcomes for patients with diabetic kidney disease (DKD), even when used alongside current standard-of-care therapies, according to research presented at the 2026 European Renal Association Congress in Glasgow, Scotland.
Of the full cohort, 39.2% were also treated with DCCBs.
They posited that DCCBs preferentially dilate blood vessels that carry blood into the kidney’s filtering units, without similarly affecting the blood vessels that carry blood away.
Notably, the elevated risks of DCCB use persisted despite concomitant SGLT2 inhibitor use, as did the increased risk for kidney disease progression.
The authors emphasized that the findings are observational and do not establish causality, calling for randomized trials to better define optimal antihypertensive strategies in DKD.
The use of dihydropyridine calcium-channel blockers (DCCBs) may be associated with worse renal outcomes for patients with diabetic kidney disease (DKD), even when used alongside current standard-of-care therapies, according to research presented at the 2026 European Renal Association Congress in Glasgow, Scotland.
The observational study analyzed data from 31,031 adults with type 2 diabetes treated between 2016 and 2021, all of whom were receiving both renin-angiotensin system inhibitors and sodium-glucose cotransporter 2 (SGLT2) inhibitors. Of the full cohort, 39.2% were also treated with DCCBs. Over a median follow-up of approximately 3.5 years, DCCB use was associated with a 33% higher risk of major adverse kidney events (risk ratio, 1.33; 95% CI, 1.03-1.73), defined as a 40% or greater decline in estimated glomerular filtration rate or progression to end-stage kidney disease.
Lead study author Timna Agur, MD, MSc, a senior nephrologist at Rabin Medical Center and director of the nephrology outpatient clinics at HaSharon Hospital in Israel, said in a press release, “DCCBs are widely used as second-line blood pressure treatments in patients with DKD. Our findings raise important questions about whether these medications are always the best option for patients already receiving modern kidney-protective therapies.”
The investigators suggested that DCCBs may contribute to ongoing kidney injury by increasing intraglomerular pressure. They posited that DCCBs preferentially dilate blood vessels that carry blood into the kidney’s filtering units, without similarly affecting the blood vessels that carry blood away. Notably, the elevated risks of DCCB use persisted despite concomitant SGLT2 inhibitor use, as did the increased risk for kidney disease progression.
The authors emphasized that the findings are observational and do not establish causality, calling for randomized trials to better define optimal antihypertensive strategies in DKD.
