Abstract: SA-OR011
Differences in Early Initiation of Cardiovascular and Nephroprotective Therapies Among US Veterans with CKD
Session Information
- CKD: Advancing Epidemiology, Risk Factors, and Prevention
November 08, 2025 | Location: Room 362A, Convention Center
Abstract Time: 04:40 PM - 04:50 PM
Category: CKD (Non-Dialysis)
- 2301 CKD (Non-Dialysis): Epidemiology, Risk Factors, and Prevention
Authors
- Swee, Melissa L., University of Iowa Health Care, Iowa City, Iowa, United States
- Gao, Yubo, University of Iowa Health Care, Iowa City, Iowa, United States
- Griffin, Benjamin R., University of Iowa Health Care, Iowa City, Iowa, United States
- Yamada, Masaaki, University of Iowa Health Care, Iowa City, Iowa, United States
- Reisinger, Heather, University of Iowa Health Care, Iowa City, Iowa, United States
- Sarrazin, Mary Vaughan, Iowa City VA Medical Center, Iowa City, Iowa, United States
- Jalal, Diana I., Iowa City VA Medical Center, Iowa City, Iowa, United States
Background
Renin-angiotensin system (RAS) inhibitors and sodium-glucose cotransporter 2 (SGLT2) inhibitors are guideline-recommended therapies to improve kidney and cardiovascular outcomes for individuals with chronic kidney disease (CKD). However, real-world adoption remains suboptimal. We evaluated patient-level factors associated with the early uptake of either therapy in a national cohort of Veterans with CKD.
Methods
Using Veterans Health Administration data from 2008–2023, we identified 1,341,797 Veterans with CKD stages 3–4. Two Cox proportional hazards models were constructed to examine time to initiation of either (1) ACE inhibitor or SGLT2 inhibitor, or (2) ARB or SGLT2 inhibitor, among patients who had not received either therapy prior to CKD index date. The event was defined as the earlier of the two drug starts. Covariates included age, sex, race/ethnicity, rurality, proteinuria (laboratory-based), comorbidities, estimated glomerular filtration rate (eGFR), and blood pressure.
Results
Older age (HR 0.98), Black race (HR 0.93–0.94), diabetes with complications (HR ~0.87), and heavy proteinuria (HR ~0.81–0.83) were associated with lower likelihood of initiating ACE/ARB or SGLT2 therapy. Heart failure was associated with divergent effects depending on therapy. Fully adjusted hazard ratios and confidence intervals are shown in Figure 1.
Conclusion
Differences exist in the early adoption of cardiovascular and nephro-protective therapies among U.S. Veterans with CKD. These findings highlight the need for targeted strategies to improve equitable, timely initiation of CKD treatments among high risk Veterans with CKD.
HRs and 95% confidence intervals evaluating factors associated with time to first initiation of ACE inhibitor or SGLT2 inhibitor (left) and ARB or SGLT2 inhibitor (right) among U.S. Veterans with CKD stages 3–4.
Funding
- Other NIH Support