Oral Contraceptives May Lead to Kidney Damage in Patients With Type I Diabetes

Peggy Peck

May 21, 2004

May 21, 2004 (New York) — New findings reported here at the American Society of Hypertension 19th annual scientific meeting suggest that women with type 1 diabetes who use oral contraceptives (OCs) are at increased risk for developing kidney disease.

"The risk of diabetic women developing albuminuria if they do not take [OCs] is about 2%, but among women who take oral contraceptives, the risk is closer to 18%," said Sofia Ahmed, MD, a research fellow in medicine at Brigham and Women's Hospital in Boston, Massachusetts.

However, Dr. Ahmed cautioned that even though her data appear to show that use of OCs is a risk factor for developing kidney damage, she isn't calling for women to stop using the pills. "Pregnancy in this population of women is not risk-free," she said. "Doctors and their patients have to weigh the risks of nephropathy versus the risk of pregnancy. The use of [OCs] in the setting of diabetes warrants further study."

Dr. Ahmed and collaborators in Denmark identified 114 women diagnosed with type 1 diabetes and reviewed their medical charts from 1984 through 2000. There were 81 women in the study who had never used OCs and 33 women with a history of OC use. She said that on average, the women used OCs for 8.4 years.

She noted that previous experiments involving healthy women have indicated that the use of OCs, including the newer third-generation contraceptives, activated the renin-angiotensin system and might result in stress on the kidneys. While the amount of estrogen in the OCs used by the women in Denmark was similar in all the pills, Dr. Ahmed said that the progestin part of the pill differed.

"Not all progestins are created equal," said Celso Gomez-Sanchez, MD, cochair of the session at which Dr. Ahmed presented her data and professor of medicine at the University of Mississippi in Jackson. Dr. Gomez-Sanchez suggested that the type of progestin and its composition in the OC might play a crucial role in the results.

ASH 19th Annual Scientific Meeting: OR26. Presented May 20, 2004.

Reviewed by Gary D. Vogin, MD

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