Abstract: FR-PO484

Real Life Insights into the Use of Mineralocorticoid Receptor Antagonists in Patients with Diabetic and Non-Diabetic CKD with and without Heart Failure

Session Information

Category: Chronic Kidney Disease (Non-Dialysis)

  • 303 CKD: Epidemiology, Outcomes - Cardiovascular

Authors

  • Blankenburg, Michael, Bayer AG, Berlin, Germany
  • Fett, Anne-Kathrin, QuintilesIMS, Frankfurt, Germany
  • Eisenring, Seline, QuintilesIMS, Frankfurt, Germany
  • Haas, Gabriele, IMS Health, Frankfurt, Germany
  • Korn, Jonathan, QuintilesIMS, Frankfurt, Germany
  • Gay, Alain, Bayer AG, BERLIN, Germany
Background

Mineralocorticoid receptor antagonists (MRAs) are part of the treatment practice for patients with heart failure (HF) and/or hypertension. This study aimed to evaluate real-life MRA utilization in patients with chronic kidney disease (CKD) with or without diabetes mellitus (DM), HF and hypertension, respectively.

Methods

This retrospective cohort study used the US claims database PharMetricsPlus between 10/2009 and 09/2014. 229,143 patients ≥18 years with a first CKD diagnosis and 5,899 patients who initiated MRAs were included in two cohorts. Demographic characteristics, comorbidities, clinical events, medication use, and healthcare costs are reported for the overall cohorts and stratified by diagnosis: CKD (only), CKD+DM, CKD+HF and CKD+DM+HF, and MRA treatment (no MRA treatment, MRAs for < 6 and ≥ 6 months).

Results

We identified 114,129 CKD, 77,012 CKD+DM, 15,567 CKD+HF, and 22,435 CKD+DM+HF patients. The results showed low MRA usage in the population of interest. Overall, 2.3% of patients used MRAs. Use within the four diagnostic groups was 1.3%, 1.9%, 6.7%, and 6.7%, respectively. Hypertension was present in 78.5% of the overall population and in 94.1% of MRA users. HF was present in 16.6% of the overall population and in 46.6% of MRA users. 27.6% of patients who took MRAs had CKD stage 4, 5 or end-stage renal disease. MRA users generally presented with higher rates of comorbidities, medication use, and higher health-care costs. One-year persistence with MRA was less than 50%.

Conclusion

The use of MRAs in CKD patients is low and seems to be driven by the presence of hypertension and HF. Yet, MRAs are also given to CKD patients beyond stage 3, despite being contraindicated in the respective labels. Patients on MRAs tended to be more multi-morbid and to show higher healthcare resource use than patients without MRA.

Funding

  • Commercial Support