Abstract: FR-OR018

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

Session Information

Category: Chronic Kidney Disease (Non-Dialysis)

  • 303 CKD: Epidemiology, Outcomes - Cardiovascular

Authors

  • Pecoits-Filho, Roberto, Pontificia Universidade Catolica do Parana, Curitiba, PARANÁ, Brazil
  • Sesso, Ricardo, Escola Paulista De Medicina, Unifesp, Sao Paulo, Brazil
  • Narita, Ichiei, Niigata University, Niigata, Japan
  • Robinson, Bruce M., Arbor Research Collaborative for Health, Ann Arbor, Michigan, United States
  • Massy, Ziad, Ambroise Pare University Hospital and Inserm U1018 Eq5, Boulogne Billancourt/ Paris cedex, France
  • Tu, Charlotte, Arbor Research Collaborative for Health, Ann Arbor, Michigan, United States
  • Zee, Jarcy, Arbor Research Collaborative for Health, Ann Arbor, Michigan, United States
  • Zepel, Lindsay, Arbor Research Collaborative for Health, Ann Arbor, Michigan, United States
  • Bieber, Brian, Arbor Research Collaborative for Health, Ann Arbor, Michigan, United States
  • Wong, Michelle M.Y., Arbor Research Collaborative for Health, Ann Arbor, Michigan, United States
  • Port, Friedrich K., Arbor Research Collaborative for Health, Ann Arbor, Michigan, United States
  • Combe, Christian, CHU de Bordeaux, Bordeaux, France
  • Fliser, Danilo, Saarland University Medical Centre, Homburg/Saar, Germany

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