Kidney Week

Abstract: TH-PO150

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

Session Information

• Clinical Glomerular Disorders: FSGS, MN, MCD
  November 02, 2017 | Location: Hall H, Morial Convention Center
  Abstract Time: 10:00 AM - 10:00 AM

Category: Glomerular

• 1005 Clinical Glomerular Disorders

Authors

• Kamil, Elaine S., Cedars Sinai Medical Center, Los Angeles, California, United States

Elaine S. Kamil,

• Elliott, Matthew, Metrolina Nephrology Associates, Charlotte, North Carolina, United States

Matthew Elliott,

• Gipson, Patrick E., University of Michigan, Ann Arbor, Michigan, United States

Patrick E. Gipson,

• Massengill, Susan F., Levine Children's Hospital , Charlotte, North Carolina, United States

Susan F. Massengill,

• Adler, Sharon G., Harbor-UCLA Medical Center, Torrance, California, United States

Sharon G. Adler,

• Pesenson, Anne, The Polyclinic, Seattle, Washington, United States

Anne Pesenson,

• Modes, Meg, Patient Advocate, Livonia, Michigan, United States

Meg Modes,

• Oh, Gia J., Stanford University, Stanford, California, United States

Gia J. Oh,

• Selewski, David T., University of Michigan, Ann Arbor, Michigan, United States

David T. Selewski,

• Lee, Lauren, NephCure Kidney International, King of Prussia, Pennsylvania, United States

Lauren Lee,

• Gipson, Debbie S., University of Michigan, Ann Arbor, Michigan, United States

Debbie S. Gipson,

• Zhong, Xuhui, Peking University First Hospital, Beijing, China

Xuhui Zhong,

• Waldo, Anne, University of Michigan, Ann Arbor, Michigan, United States

Anne Waldo,

• Troost, Jonathan P., University of Michigan, Ann Arbor, Michigan, United States

Jonathan P. Troost,

• Lafayette, Richard A., Stanford University, Stanford, California, United States

Richard A. Lafayette,

Background

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.

Methods

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.

Results

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.

Conclusion

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.

Funding

• Private Foundation Support