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Abstract: TH-PO854

Changing Patterns of Antihypertensive Treatment Among CKD Patients: The CKD-REIN Cohort Study

Session Information

Category: CKD (Non-Dialysis)

  • 2201 CKD (Non-Dialysis): Epidemiology‚ Risk Factors‚ and Prevention

Authors

  • Costes-Albrespic, Margaux, Centre de Recherche en Epidemiologie et Sante des Populations, Villejuif, Île-de-France, France
  • Laville, Solene M., Centre Hospitalier Universitaire Amiens-Picardie, Amiens, Hauts-de-France, France
  • Liabeuf, Sophie, Centre Hospitalier Universitaire Amiens-Picardie, Amiens, Hauts-de-France, France
  • Jacquelinet, Christian, Agence de la biomedecine, La Plaine Saint-Denis, France
  • Combe, Christian, Centre Hospitalier Universitaire de Bordeaux Groupe hospitalier Pellegrin, Bordeaux, Aquitaine, France
  • Fouque, Denis, Hospices Civils de Lyon, Lyon, Auvergne-Rhône-Alpes , France
  • Laville, Maurice, Universite Claude Bernard Lyon 1, Lyon, Auvergne-Rhône-Alpes , France
  • Ayav, Carole, Centre hospitalier regional universitaire de Nancy, Nancy, Lorraine, France
  • Massy, Ziad, Centre de Recherche en Epidemiologie et Sante des Populations, Villejuif, Île-de-France, France
  • Pecoits-Filho, Roberto, Arbor Research Collaborative for Health, Ann Arbor, Michigan, United States
  • Stengel, Benedicte, Centre de Recherche en Epidemiologie et Sante des Populations, Villejuif, Île-de-France, France
  • Sautenet, Benedicte, Centre Hospitalier Regional Universitaire de Tours, Tours, Centre, France
  • Alencar de Pinho, Natalia, Centre de Recherche en Epidemiologie et Sante des Populations, Villejuif, Île-de-France, France
Background

Blood pressure (BP) control is one of the cornerstones for preventing cardiorenal complications in chronic kidney disease (CKD). Yet, despite a wide range of treatments, a majority of patients remain off-target. We aimed at describing changes in antihypertensive treatment regimens in this population.

Methods

We collected drug prescriptions over 5 years among 2,755 hypertensive patients with CKD stages 3 and 4 recruited from a nationally representative sample of 40 nephrology clinics in France. Using the international Anatomic Therapeutic and Chemical codes, we classified antihypertensive drugs into 14 mutually exclusive classes, and assessed time-dependent prescription status until death, kidney replacement therapy, or censoring.

Results

At baseline, 81% of the patients (mean age, 67; 66% men; mean eGFR 33 mL/min/1.73 m2) had BP ≥130/80 mmHg. We identified 257 distinct antihypertensive drug class regimens. The most prescribed class were RAS inhibitors (78%), and the most frequent combination, RAS inhibitors with diuretics (9%). BP level did not significantly differ according to the number of antihypertensive drugs. Over a median of 5 years of follow-up (IQR 4.5; 5.1), half of the patients changed their treatment regimen. These changes included adding-on, withdrawing or changing a drug class in 22%, 19%, and 10% of cases, respectively, and resulted in virtually no progression in the number of prescribed drug classes per patient at the end of follow-up (Figure). Analyses by drug classes revealed highest rates of regimen increments for β-blockers (46%) and for diuretics in addition with drug classes other than RAS inhibitors (35%).

Conclusion

This study highlights substantial heterogeneity of antihypertensive drug prescriptions among CKD patients under nephrology care. Greater knowledge of the evolving patterns of antihypertensive treatment regimens is a first, but key step in the understanding of the determinants of BP control in CKD.

Funding

  • Government Support – Non-U.S.