Kidney Week

Abstract: TH-PO1026

ACEi/Angiotensin Receptor Blocker (ARB) Prescribing Practices and Patient Experiences in CKD: A Qualitative Study of Clinicians and Patients

Session Information

• CKD Epidemiology, Risk Factors, Prevention - I
  November 02, 2023 | Location: Exhibit Hall, Pennsylvania Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: CKD (Non-Dialysis)

• 2301 CKD (Non-Dialysis): Epidemiology, Risk Factors, and Prevention

Authors

• Gregg, L Parker, Baylor College of Medicine, Houston, Texas, United States

L Parker Gregg,

• Arney, Jennifer, University of Houston Clear Lake, Houston, Texas, United States

Jennifer Arney,

• Wydermyer, Sheena R., Michael E DeBakey VA Medical Center, Houston, Texas, United States

Sheena R. Wydermyer,

• Herrera, Michael Alexander, Baylor College of Medicine, Houston, Texas, United States

Michael Alexander Herrera,

• Richardson, Peter, Michael E DeBakey VA Medical Center, Houston, Texas, United States

Peter Richardson,

• Matheny, Michael Edwin, Vanderbilt University Medical Center, Nashville, Tennessee, United States

Michael Edwin Matheny,

• Akeroyd, Julia, Baylor College of Medicine, Houston, Texas, United States

Julia Akeroyd,

• Gobbel, Glenn T., Vanderbilt University Medical Center, Nashville, Tennessee, United States

Glenn T. Gobbel,

• Hung, Adriana, Vanderbilt University Medical Center, Nashville, Tennessee, United States

Adriana Hung,

• Virani, Salim S., The Aga Khan University, Karachi, Sindh, Pakistan

Salim S. Virani,

• Navaneethan, Sankar D., Baylor College of Medicine, Houston, Texas, United States

Sankar D. Navaneethan,

Background

Angiotensin converting enzyme inhibitors (ACEi) and angiotensin receptor blockers (ARB) improve clinical outcomes but are underutilized in chronic kidney disease (CKD). Little is known about reasons for discontinuation and lack of reinitiating these medications, which contributes to underutilization.

Methods

We conducted in-depth interviews with a multi-profession sample of clinicians and patients with documented ACEi/ARB side effects in the past 6 months. Participants were recruited from 2 Veterans Affairs (VA) healthcare systems. We used inductive and deductive qualitative data analysis approaches to identify themes related to experiences with ACEi/ARB. Thematic analysis focused on prescribing decisions and practices, clinical guidelines, and perception of side effects. Data were analyzed as they amassed. Recruitment was stopped at the point of thematic saturation.

Results

Participants included 15 clinicians (primary care, geriatrics, cardiology, and endocrinology; 8 physicians, 3 NPs/PAs, 4 clinical pharmacists) and 10 patients (mean age 69 years, 40% men). Clinicians prescribe ACEi/ARB for blood pressure control and kidney protection, and many emphasized the role these agents play in diabetes management. Clinicians described providing comprehensive patient education about CKD and ACEi/ARB. However, patient interviews revealed knowledge gaps about CKD and the need for ACEi/ARB, with many patients unaware of their CKD diagnosis or why they had been prescribed ACEi/ARB. Clinicians’ drug management strategies and understanding of prescribing guidelines varied widely. They identified structural and patient-level barriers to prescribing, and many endorsed the development of a decision support tool to facilitate ACEi/ARB prescribing and management (Figure).

Conclusion

Our qualitative exploration of clinicians’ and patients’ experiences with ACEi/ARB will inform the development of a decision support tool to improve prescription rates of these agents for patients with CKD.

Funding

• Veterans Affairs Support