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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