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Kidney Week

Abstract: FR-OR116

Real World Dosing Practices of Renin-Angiotensin-Aldosterone System Inhibitors Is Associated with Risk of Adverse Clinical Events in CKD Patients

Session Information

Category: CKD (Non-Dialysis)

  • 1902 CKD (Non-Dialysis): Clinical, Outcomes, and Trials


  • Qin, Lei, AstraZeneca, Gaithersburg, Maryland, United States
  • Furuland, Hans, University Hospital, Uppsala, Uppsala, Sweden
  • Ayoubkhani, Daniel, Health Economics and Outcomes Research Ltd, Cardiff, United Kingdom
  • Evans, Marc Lyndon, University Hospital Llandough, Cardiff, United Kingdom
  • Linde, Cecilia, Karolinska University Hospital, Stockholm, Sweden
  • Bakhai, Ameet, Royal Free London Hospitals NHS Foundation Trust, Barnet, United Kingdom
  • Grandy, Susan, Astrazeneca, Gaithersburg, Maryland, United States
  • Palaka, Eirini, AstraZeneca, Gaithersburg, Maryland, United States
  • McEwan, Philip, Health Economics and Outcomes Research Ltd, Cardiff, United Kingdom

This study estimated real-world relationships between renin-angiotensin-aldosterone system inhibitors (RAASi) dosing in chronic kidney disease (CKD) patients and the incidence of all-cause mortality and major adverse cardiovascular events (MACE).


Data from the UK Clinical Practice Research Datalink and linked Hospital Episode Statistics between Jan 2006 and Dec 2015 were used to identify adult non-dialysis patients with incident CKD stage 3+ (based on codes or eGFR ≤60 mL/min/1.73m2). Kaplan-Meier survival curves were stratified by <50% and ≥50% of guideline-recommended RAASi dose. Adjusted odds ratios (ORs) relating RAASi dosing to mortality and MACE were estimated using Generalized Estimating Equations.


100,572 patients were included in the study (mean follow-up 6 years). Mortality rates for patients prescribed <50% and ≥50% of recommended RAASi dose were 58 and 11 events per 1,000 patient-years, respectively; the corresponding rates of MACE were 141 and 82 events respectively. Risk of mortality over time was greater for patients prescribed <50% RAASi dose compared to those prescribed ≥50% (Figure 1). Adjusted ORs for mortality and MACE were 3.77 and 1.57 (both p<0.0001), respectively, comparing patients prescribed <50% and ≥50% RAASi dose.


CKD patients prescribed <50% RAASi dose were at significantly higher risk of mortality and MACE compared to those prescribed ≥50%. Although adjustment for factors such as clinician risk appreciation was not possible, the results highlight the need for treatment strategies that allow the prescription of recommended RAASi doses to optimize patient benefit.

Figure 1. Mortality rates stratified by RAASi dose


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