ASN's Mission

To create a world without kidney diseases, the ASN Alliance for Kidney Health elevates care by educating and informing, driving breakthroughs and innovation, and advocating for policies that create transformative changes in kidney medicine throughout the world.

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: TH-PO607

Adverse Drug Reactions (ADRs) and Underutilization of ACE Inhibitors and ARBs in CKD

Session Information

Category: Hypertension and CVD

  • 1501 Hypertension and CVD: Epidemiology‚ Risk Factors‚ and Prevention

Authors

  • Gregg, L Parker, Baylor College of Medicine, Houston, Texas, United States
  • Richardson, Peter, Baylor College of Medicine, Houston, Texas, United States
  • Akeroyd, Julia, Baylor College of Medicine, Houston, Texas, United States
  • Gobbel, Glenn T., Vanderbilt University Medical Center, Nashville, Tennessee, United States
  • Arney, Jennifer, University of Houston Clear Lake, Houston, Texas, United States
  • Jafry, Shehrezade A., Baylor College of Medicine, Houston, Texas, United States
  • Hung, Adriana, Vanderbilt University Medical Center, Nashville, Tennessee, United States
  • Matheny, Michael Edwin, Vanderbilt University Medical Center, Nashville, Tennessee, United States
  • Virani, Salim S., Baylor College of Medicine, Houston, Texas, United States
  • Navaneethan, Sankar D., Baylor College of Medicine, Houston, Texas, United States
Background

ACEi/ARB are underprescribed in patients with chronic kidney disease (CKD). We identified factors associated with never receiving an ACEi/ARB and associations with ADRs among patients with CKD.

Methods

Using the Veterans Affairs (VA) Corporate Data Warehouse, we identified patients with CKD stages 3-4 from 2005-2019 based on laboratory data. Groups were defined as those prescribed an ACEi/ARB at the time of meeting criteria for CKD (current user group), those for whom an ACEi/ARB had previously been prescribed and discontinued (discontinued group), and those who had never been prescribed an ACEi/ARB in the VA system (never prescribed group). Logistic regression assessed factors associated with never being prescribed an ACEi/ARB and odds of having a documented ADR in 17 categories.

Results

There were 889,453 (50.0%) individuals in the current group, 332,074 (18.6%) in the discontinued group, and 557,903 (31.4%) in the never prescribed group. In multivariable models, older and female participants were more likely to have never been prescribed an ACEi/ARB. Those with heart failure, diabetes, and hypertension had markedly lower odds of never being prescribed an ACEi/ARB (Figure 1A). A documented ADR was present in 2.9% and 1.0% of the discontinued and never groups, respectively. Compared to the discontinued group, the never prescribed group was less likely to have an ADR related to hyperkalemia (OR 0.5, 95% CI 0.4-0.5) or general, neurological, or gastrointestinal symptoms, but more likely to have angioedema (OR 1.2, 95% CI 1.1-1.3), cough (OR 1.1, 95% CI 1.05-1.2), peripheral edema (OR 1.3, 95% CI 1.1-1.4), dyspnea (OR 1.4, 95% CI 1.2-1.8), or allergic reaction (OR 1.4, 95% CI 1.2-1.5) (Figure 1B).

Conclusion

Rates of documented ADRs were low among patients not on ACEi/ARB. ADR types differed between the never prescribed and discontinued groups. Future research should address clinical inertia to prescribing these agents to slow the progression of kidney disease.

Funding

  • Veterans Affairs Support