title: Understanding antihypertensive medication use after living kidney donation through linked national registry and pharmacy claims data.
abstract: BACKGROUND
  Use of antihypertensive medications (AHM) after living kidney donation is not well described.
  
  
  METHODS
  We examined a database wherein national transplant registry data for 4,650 living kidney donors in 1987-2007 were linked to pharmacy claims from a US private health insurer (2000-2007 claims) to identify post-donation AHM fills. Cox regression with left- and right-censoring was used to estimate the frequencies and relative likelihood (adjusted hazards ratios, aHR) of post-donation AHM fills according to donor demographic traits. Medication possession ratio (MPRs), defined as (days of AHM dispensed)/(days observed), were also compared among donors and non-donor general beneficiaries.
  
  
  RESULTS
  Overall, 17.8% of the sample filled at least one AHM by 5 years post-donation. As compared with White living donors, African-Americans had 37% higher relative likelihood of any AHM use after donation (aHR 1.37, p < 0.0007), including significantly higher likelihoods of filling diuretics (aHR 2.25, p < 0.0001), ACEi/ARBs (aHR 1.46, p < 0.01), calcium channel blockers (aHR 1.56, p = 0.03), and vasodilators/other agents (aHR 2.17, p = 0.03). MPRs for any AHM and subcategories were lower among donors compared with age- and sex-matched non-donors. However, AHM MPRs rose in donors with multiple hypertension diagnoses, and prescription fill exposure for all AHM classes except diuretics was similar among donors and general non-donors with ≥ 3 hypertension diagnoses.
  
  
  CONCLUSIONS
  While AHM requirements are lower after kidney donation than among unscreened general persons, racial variation in AHM use occurs in privately insured donors. Demonstration of pharmaceutical care needs of insured donors supports the need for long-term follow-up and healthcare access for all donors.
authors.affiliation: Center for Outcomes Research, Saint Louis University School of Medicine, St. Louis, Mo., USA.
authors.forename: Krista L
authors.initials: KL
authors.lastname: Lentine
authors.forename: Mark A
authors.initials: MA
authors.lastname: Schnitzler
authors.forename: Amit X
authors.initials: AX
authors.lastname: Garg
authors.forename: Huiling
authors.initials: H
authors.lastname: Xiao
authors.forename: David
authors.initials: D
authors.lastname: Axelrod
authors.forename: Janet E
authors.initials: JE
authors.lastname: Tuttle-Newhall
authors.forename: Daniel C
authors.initials: DC
authors.lastname: Brennan
authors.forename: Dorry L
authors.initials: DL
authors.lastname: Segev
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D002121:Calcium Channel Blockers / Q000627:therapeutic use; D004232:Diuretics / Q000627:therapeutic use; D011307:Drug Prescriptions / Q000706:statistics & numerical data*; D005260:Female; D006630:Hispanic or Latino / Q000706:statistics & numerical data; D006801:Humans; D006973:Hypertension / Q000175:diagnosis / Q000188:drug therapy*; D007356:Insurance, Pharmaceutical Services / Q000706:statistics & numerical data; D016030:Kidney Transplantation; D019520:Living Donors / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D012042:Registries / Q000706:statistics & numerical data; D044465:White People / Q000706:statistics & numerical data
chemical_list: D000319:Adrenergic beta-Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D000959:Antihypertensive Agents; D002121:Calcium Channel Blockers; D004232:Diuretics