title: Reporting of the estimated glomerular filtration rate was associated with increased use of angiotensin-converting enzyme inhibitors and angiotensin-II receptor blockers in CKD.
abstract: Many guidelines suggest that angiotensin-converting enzyme inhibitors and angiotensin-II receptor antagonists (collectively referred to as renin, angiotensin, aldosterone system blockers (RAAS blockers)) are the preferred treatment for hypertension in most patients with chronic kidney disease (CKD). Improving the recognition of CKD with the introduction of eGFR reporting was intended to have more patients recognized with and treated for this disease. To quantify this, we examined trends in RAAS-blocker use over an 88-month period before and after routine eGFR reporting in southwestern Ontario, Canada. An intervention analysis with seasonal time-series modeling on linked health administrative data for 45,361 ambulatory residents with CKD (eGFR stages 3-5) older than 65 years was performed with a primary outcome of RAAS-blocker usage. The reporting of eGFR was associated with a significant increase in the use of RAAS blockers, as the prescription rate was 571 per 1000 patients with CKD prior to reporting but improved to 607 per 1000 after reporting. There was a significant increase in RAAS-blocker use attributable to eGFR reporting of 19 per 1000 CKD patients. Since about 8% of the adult population has CKD, this equates to about 15,200 new patients receiving RAAS-blocker treatment by 1 year after the introduction of eGFR reporting in community laboratories. Thus, eGFR reporting contributes to improved, guideline-appropriate care of older patients with CKD.
authors.affiliation: London Kidney Chemical Research Unit, Division of Nephrology, Department of Medicine, London Health Science Center, University of Western Ontario, London, Canada. arsh.jain@lhsc.on.ca
authors.forename: Arsh K
authors.initials: AK
authors.lastname: Jain
authors.forename: Meaghan S
authors.initials: MS
authors.lastname: Cuerden
authors.forename: Ian
authors.initials: I
authors.lastname: McLeod
authors.forename: Brenda
authors.initials: B
authors.lastname: Hemmelgarn
authors.forename: Ayub
authors.initials: A
authors.lastname: Akbari
authors.forename: Marcello
authors.initials: M
authors.lastname: Tonelli
authors.forename: Rob R
authors.initials: RR
authors.lastname: Quinn
authors.forename: Matt J
authors.initials: MJ
authors.lastname: Oliver
authors.forename: Amit X
authors.initials: AX
authors.lastname: Garg
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D047228:Angiotensin II Type 1 Receptor Blockers / Q000627:therapeutic use*; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use*; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D002908:Chronic Disease; D011307:Drug Prescriptions; D004363:Drug Utilization; D017723:Drug Utilization Review; D005260:Female; D005919:Glomerular Filtration Rate / Q000187:drug effects*; D019983:Guideline Adherence; D006801:Humans; D006973:Hypertension / Q000175:diagnosis / Q000188:drug therapy* / Q000503:physiopathology; D007668:Kidney / Q000187:drug effects* / Q000503:physiopathology; D007674:Kidney Diseases / Q000175:diagnosis / Q000188:drug therapy* / Q000503:physiopathology; D007677:Kidney Function Tests; D008297:Male; D008875:Middle Aged; D009864:Ontario; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D011237:Predictive Value of Tests; D012084:Renin-Angiotensin System / Q000187:drug effects*; D012720:Severity of Illness Index; D013997:Time Factors
chemical_list: D047228:Angiotensin II Type 1 Receptor Blockers; D000806:Angiotensin-Converting Enzyme Inhibitors; D000959:Antihypertensive Agents