ASN's Mission

ASN leads the fight to prevent, treat, and cure kidney diseases throughout the world by educating health professionals and scientists, advancing research and innovation, communicating new knowledge, and advocating for the highest quality care for patients.

learn more

Contact ASN

1401 H St, NW, Ste 900, Washington, DC 20005

email@asn-online.org

202-640-4660

The Latest on Twitter

Kidney Week

Abstract: PO2312

Submaximal Dose of Angiotensin Converting Enzyme Inhibitor and Angiotensin II Receptor Blockers Among Persons with Proteinuria

Session Information

Category: CKD (Non-Dialysis)

  • 2101 CKD (Non-Dialysis): Epidemiology, Risk Factors, and Prevention

Authors

  • Chu, Chi D., University of California San Francisco, San Francisco, California, United States
  • Powe, Neil R., University of California San Francisco, San Francisco, California, United States
  • Estrella, Michelle M., University of California San Francisco, San Francisco, California, United States
  • Shlipak, Michael, University of California San Francisco, San Francisco, California, United States
  • Mccoy, Ian, University of California San Francisco, San Francisco, California, United States
  • Tuot, Delphine S., University of California San Francisco, San Francisco, California, United States
Background

Underutilization of angiotensin converting enzyme inhibitors (ACEi) and angiotensin II receptor blockers (ARB) for treatment of albuminuria is a known quality of care gap. Among those treated with ACEi/ARB, submaximal doses represents another opportunity to improve CKD management.

Methods

Using the OptumLabs Data Warehouse®, a longitudinal, real-world dataset with deidentified claims and electronic health record data, we identified adults with proteinuria, defined as either urine albumin/creatinine ≥30 mg/g or protein/creatinine ≥150 mg/g, who were prescribed an ACEi/ARB between 1/1/2015 and 12/31/2016. Among patients without apparent contraindication to ACEi/ARB dose escalation (blood pressure <130/80 mmHg, eGFR <15 ml/min/1.73m2, or prior diagnosis of acute kidney injury or hyperkalemia), we examined the proportion taking the maximal recommended dose of their ACEi/ARB, overall and by demographic and clinical factors. We used multivariable logistic regression to assess factors associated with submaximal dosing.

Results

Of 79,413 patients with proteinuria receiving ACEi/ARB therapy, 50% (n=39,733) had no apparent contraindication to dose escalation. 34% (n=13,566) of these patients were on maximal ACEi/ARB doses. In multivariable analyses, younger age, Asian race, Hispanic ethnicity, higher serum potassium, and non-diabetes status were associated with submaximal dosing (Figure).

Conclusion

Among persons with proteinuria and no apparent contraindication for ACEi/ARB dose escalation, over half were on submaximal doses. Concerns over hyperkalemia may drive underdosing. However, greater attention toward maximizing ACEi/ARB dose as tolerated, especially among patients without diabetes, could optimize cardiovascular and kidney health.

Funding

  • NIDDK Support