Abstract: SA-PO747
Temporal Trends in the Utilization of Hydralazine and Diagnoses of ANCA-Associated Glomerulonephritis
Session Information
- ANCA-Associated Vasculitis, Anti-GBM Disease, and Other RPGN
October 26, 2024 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Glomerular Diseases
- 1402 Glomerular Diseases: Clinical, Outcomes, and Therapeutics
Authors
- Braga, Juarez R., University of Arkansas for Medical Sciences, Little Rock, Arkansas, United States
- Muni Reddy, Swathi, University of Arkansas for Medical Sciences, Little Rock, Arkansas, United States
- Cassol, Clarissa Araujo, Arkana Laboratories, Little Rock, Arkansas, United States
- Arthur, John M., University of Arkansas for Medical Sciences, Little Rock, Arkansas, United States
Background
Hydralazine is used in clinical praactice in the management of hypertension and heart failure. However, hydralazine is associated to the development of ANCA antibodies which can then in turn cause pauci-immune glomerulonephritis (GN). We designed this study to examine temporal trends in the use of hydralazine and in the number of individuals diagnosed with biopsy-proven hydralazine-associated ANCA-GN.
Methods
This study included 2 analyses: (i) a repeated cross-sectional study examining the use of hydralazine among Medicare beneficiaries using Part D Prescription data from 2013 to 2021; (ii) an observational study of ANCA-GN diagnosed with a kidney biopsy at a single renal pathology center, Arkana Laboratories, from 2016 to 2021. From the Medicare part D files, we extracted the number of beneficiaries, the total number of claims, and claims according to provider specialty for hydralazine. Prescription rate was expressed per 100,000 beneficiaries and per 1,000 providers. From the pathology laboratory, we identified cases diagnosed with pauci-immune GN using the ICD code N01.7. Electronic records were then reviewed for a history of positive ANCA antibodies and exposure to hydralazine.
Results
The number of Part D enrollees increased from 35.1 million in 2013 to 46 million in 2021. Meanwhile, the proportion of beneficiaries receiving hydralazine increased from 2% to 2.9%. In absolute numbers, that represented an increase from 718,433 to 1,324,532 beneficiaries in use of hydralazine (P < .001). There was an increase in the prescription rate of hydralazine among cardiologists from 1,271 claims per 100,00 beneficiaries in 2013 to 1,639 per 100,000 in 2021 (P < .001). The prescription rate, when examined per 1,000 providers, also increased from 41,287 claims in 2013 to 52,795 in 2021 among cardiologists (P < .001). This trend was not observed among nephrologists or internists. The number of individuals in use of hydralazine diagnosed with biopsy-proven ANCA-GN increased from 16 cases in 2016 to 36 in 2021 (P < .001).
Conclusion
The number of Medicare beneficiaries using hydralazine and the number of biopsy-proven hydralazine-associated ANCA-GN increased significantly over time. Those trends could have broad implications for Medicare spending with dialysis.
Funding
- Commercial Support – Arkana Laboratories