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Kidney Week

Abstract: FR-PO174

Trends in Angiotensin Converting Enzyme Inhibitor and Angiotensin II Receptor Blocker Use Among Those with CKD in the United States

Session Information

Category: CKD (Non-Dialysis)

  • 1901 CKD (Non-Dialysis): Epidemiology, Risk Factors, and Prevention

Authors

  • Murphy, Daniel P., University of Minnesota, Minneapolis, Minnesota, United States
  • Foley, Robert N., University of Minnesota, Minneapolis, Minnesota, United States
Background

Angiotensin converting enzyme inhibitors or angiotensin II receptor blockers (ACE/ARB) are first-line anti-hypertensives in chronic kidney disease (CKD). Even though evidence-based treatment of hypertension has changed considerably, and hypertension is common in CKD, nationally-representative, contemporary information regarding ACE/ARB use in CKD is lacking.

Methods

We examined ACE/ARB trends and racial/ethnic and other demographic disparities among adult National Health and Nutrition Examination Survey participants from years 1999 to 2014 with creatinine-based estimated glomerular filtration rate (eGFR) < 60 ml/min/1.73m2 or albumin-creatinine ratio (ACR) ≥ 30 mg/g.

Results

33.9% of participants with CKD used ACE/ARB. Although ACE/ARB use in CKD rose across the four eras studied (P < 0.001), estimates changed little in the last 3 eras: 1999-2002, 24.1%; 2003-2006, 33.0%; 2007-2010, 38.0%; and 2011-2014, 38.7%. ACE/ARB use was greater in those of non-Hispanic white (35.3%) and black (37.0%) and lower in those of Hispanic (25.4%) and other (28.7%) race/ethnicity. In models that adjusted for age, sex and race/ethnicity, ACE-ARBs were associated (P < 0.05) with: era (adjusted odds ratios (AOR) 1.52 [95% CI: 1.21-1.92] for 2003-2006, 1.94 [95% CI: 1.56-2.41] for 2007-2010, and 2.07 [95% CI: 1.64-2.62] for 2011-2014, vs. 1999-2002) and non-Hispanic black race/ethnicity (AOR 1.41 [95% CI: 1.18-1.68], vs. non-Hispanic white). Other multivariate associations included older age, male sex, BMI ≥ 30 kg/m2, diabetes mellitus, hypertension, cardiac failure, and myocardial infarction.

Conclusion

ACE/ARB use is the exception in community-based CKD. Although use increased early in the current millennium, subsequent estimates remained static. When age and sex are considered, disparities against participants from racial/ethnic minority subgroups were not apparent.