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Kidney Week

Abstract: TH-PO150

Factors Associated with the Initiation of renin-Angiotensin-Aldosterone System Blockade in Patients with Sustained Proteinuria

Session Information

Category: Glomerular

  • 1005 Clinical Glomerular Disorders


  • Kamil, Elaine S., Cedars Sinai Medical Center, Los Angeles, California, United States
  • Elliott, Matthew, Metrolina Nephrology Associates, Charlotte, North Carolina, United States
  • Gipson, Patrick E., University of Michigan, Ann Arbor, Michigan, United States
  • Massengill, Susan F., Levine Children's Hospital , Charlotte, North Carolina, United States
  • Adler, Sharon G., Harbor-UCLA Medical Center, Torrance, California, United States
  • Pesenson, Anne, The Polyclinic, Seattle, Washington, United States
  • Modes, Meg, Patient Advocate, Livonia, Michigan, United States
  • Oh, Gia J., Stanford University, Stanford, California, United States
  • Selewski, David T., University of Michigan, Ann Arbor, Michigan, United States
  • Lee, Lauren, NephCure Kidney International, King of Prussia, Pennsylvania, United States
  • Gipson, Debbie S., University of Michigan, Ann Arbor, Michigan, United States
  • Zhong, Xuhui, Peking University First Hospital, Beijing, China
  • Waldo, Anne, University of Michigan, Ann Arbor, Michigan, United States
  • Troost, Jonathan P., University of Michigan, Ann Arbor, Michigan, United States
  • Lafayette, Richard A., Stanford University, Stanford, California, United States

Renin-angiotensin-aldosterone system (RAAS) blockade plays an important role in the treatment of sustained proteinuria. The goal of this study was to investigate the time from the onset of sustained proteinuria to initiation of RAAS blockade therapy and associated characteristics.


Electronic health record derived NephCure Accelerating Cures Institute cohort data were used. Patients with primary proteinuric kidney disease and onset of sustained proteinuria, defined as two or more days within 6 months with measurements of UP:C>1 or dipstick proteinuria ≥2+, were eligible. Kaplan-Meier analysis was used to evaluate the time to initiation of RAAS blockade from the date of the second qualifying proteinuria measurement.


Of 848 registry patients, 147 patients were excluded due to prior RAAS therapy and 496 due to intermittent proteinuria. 205 patients were eligible for this analysis. 89 (43%) patients were prescribed RAAS blockade, 64 of 110 adults and 25 of 95 children. The median time from onset of sustained proteinuria until initiation of RAAS blockade was 241 days (IQR 35 to 653). Patients with Focal Segmental Glomerulosclerosis (FSGS) or Membranous Nephropathy (MN) were more likely to receive RAAS blockade and receive it earlier than Minimal Change or NS-not biopsied patients (Figure). In a multivariable Cox-proportional hazards model, diagnosis but not age or sex, was a significant factor associated with time to initiation of therapy.


Following onset of sustained proteinuria, RAAS blockade was initiated within a median of 8 months. Patients with a diagnosis of FSGS or MN were more likely to be treated and to be treated earlier. This study highlights opportunities for improvements in health care delivery.


  • Private Foundation Support