Kidney Week

Abstract: FR-OR018

Are RAASi Underused in Moderate to Advanced CKD? Early Findings from CKDopps

Session Information

• CKD-CV Axis: Epidemiology and Outcomes
  November 03, 2017 | Location: Room 262, Morial Convention Center
  Abstract Time: 05:54 PM - 06:06 PM

Category: Chronic Kidney Disease (Non-Dialysis)

• 303 CKD: Epidemiology, Outcomes - Cardiovascular

Authors

• Pecoits-Filho, Roberto, Pontificia Universidade Catolica do Parana, Curitiba, PARANÁ, Brazil

Roberto Pecoits-Filho, MD, PhD, FASN



Roberto Pecoits-Filho is professor at the School of Medicine, Catholic University of Parana. He was a fellow at the University of Missouri and received his PhD in nephrology at the University of São Paulo. Dr Pecoits was a visiting Scholar at the Karolinska Institute in Stockholm and is a visiting Professor at the George Institute for Global Health in Australia. He has published more than 200 articles in indexed journals, and has lectured in over 40 countries. Dr Pecoits is a national leader in several multicentre tials, and is the National Leader of the CKDOPPS Brazil and BRAZPD Studies. He sits at the executive committee of the ISN.

• Tu, Charlotte, Arbor Research Collaborative for Health, Ann Arbor, Michigan, United States

Charlotte Tu,

• Zee, Jarcy, Arbor Research Collaborative for Health, Ann Arbor, Michigan, United States

Jarcy Zee,

• Zepel, Lindsay, Arbor Research Collaborative for Health, Ann Arbor, Michigan, United States

Lindsay Zepel,

• Bieber, Brian, Arbor Research Collaborative for Health, Ann Arbor, Michigan, United States

Brian Bieber,

• Wong, Michelle M.Y., Arbor Research Collaborative for Health, Ann Arbor, Michigan, United States

Michelle M.Y. Wong,

• Port, Friedrich K., Arbor Research Collaborative for Health, Ann Arbor, Michigan, United States

Friedrich K. Port,

• Combe, Christian, CHU de Bordeaux, Bordeaux, France

Christian Combe,

• Fliser, Danilo, Saarland University Medical Centre, Homburg/Saar, Germany

Danilo Fliser,

• Sesso, Ricardo, Escola Paulista De Medicina, Unifesp, Sao Paulo, Brazil

Ricardo Sesso,

• Narita, Ichiei, Niigata University, Niigata, Japan

Ichiei Narita,

• Robinson, Bruce M., Arbor Research Collaborative for Health, Ann Arbor, Michigan, United States

Bruce M. Robinson,

• Massy, Ziad, Ambroise Pare University Hospital and Inserm U1018 Eq5, Boulogne Billancourt/ Paris cedex, France

Ziad Massy,

Group or Team Name

• On behalf of CKDopps and CKD REIN investigators

Background

Current guidelines support prescription of RAASi for CKD patients (pts) with comorbidities such as diabetes and heart failure (HF). These drugs may be underused, particularly due to hyperkalemia as a side effect of RAASi. We hypothesize that the use of RAASi in advanced CKD is influenced by the presence of hyperkalemia and the use of potassium (K) binders, diuretics, and bicarbonate.

Methods

We used data from CKDopps (2013-2017), a multinational cohort study of pts with eGFR <60 ml/min/1.73m² to describe RAASi prescription patterns by country and patient subgroups. Brazil (BR), Germany (GER), and the US are shown; data from France and Japan are forthcoming.

Results

Among 2,817 pts, ranges by country were: mean age 66-74 years; eGFR <30 69%-74%; HF 17%-19%; diabetes 41-58%; serum potassium ≥5 21-35%; albuminuria 50-69%. RAASi prescription was more common in GER (80%) than BR (66%) and US (54%); less common in CKD stage 5 in all countries; less common with higher serum K in US; and lower with albuminuria in GER and US (Table 1). RAASi use was higher among pts with (vs. without) CHF/diabetes in BR, but only for diabetes in US. Among pts prescribed RAASi, prescriptions of loop or thiazide diuretics were 68-74%; resins were 6% in GER, almost absent in BR and US; and bicarbonate was 6-8%.

Conclusion

RAASi prescription patterns in CKD vary by country, demographic, and clinical characteristics. RAASi may be underused, especially in the US where only half were prescribed a RAASi even among pts with strong class-specific recommendations including albuminuria, diabetes, or heart failure. Antihyperkalemia measures, such as dietary restriction, loop diuretics, bicarbonate and K binders may raise RAASi use.

Funding

• Commercial Support –