Journal
JOURNAL OF CLINICAL HYPERTENSION
Volume 21, Issue 7, Pages 991-1001Publisher
WILEY
DOI: 10.1111/jch.13563
Keywords
albuminuria; chronic kidney disease; diabetes; heart failure; renin-angiotensin-aldosterone system inhibitors
Categories
Funding
- Vifor Fresenius Medical Renal Pharma Ltd.
- Amgen
- AstraZeneca Pharmaceuticals LP
- Baxter Healthcare Corp
- European Renal Association-European Dialysis & Transplant Association (ERA-EDTA)
- Fresenius Medical Care Asia-Pacific Ltd
- Fresenius Medical Care Canada Inc
- German Society of Nephrology (DGfN)
- Italian Society of Nephrology (SIN)
- Janssen Pharmaceuticals Inc
- Japanese Society for Peritoneal Dialysis (JSPD)
- Keryx Biopharmaceuticals, Inc
- Kidney Care UK
- Kyowa Hakko Kirin Co., Ltd
- MEDICE Arzneimittel Putter GmbH Co KG
- Otsuka America Pharmaceutical, Inc
- Proteon Therapeutics, Inc
- Association of German Nephrology Centres (Verband Deutsche Nierenzentren eV)
- Australia-National Health & Medical Research Council (NHMRC)
- Belgium-Belgian Federal Public Service of Public Health
- Canada-Cancer Care Ontario (CCO) through the Ontario Renal Network (ORN)
- France-French National Institute of Health and Medical Research (INSERM)
- Thailand-Thailand Research Foundation (TRF)
- Thailand-Chulalongkorn University
- Thailand-King Chulalongkorn Memorial Hospital
- Thailand-National Research Council of Thailand (NRCT)
- United Kingdom-National Institute for Health Research (NIHR) via the Comprehensive Clinical Research Network (CCRN)
- Agence Nationale de la Recherche
- 2010 national Programme Hospitalier de Recherche Clinique
- Fresenius Medical Care
- GlaxoSmithKline (GSK)
- Lilly France
- Otsuka Pharmaceutical
- Baxter
- Merck Sharp & Dohme-Chibret (MSD France)
- Sanofi-Genzyme
- WiNe (Wissenschaftliches Institut fur Nephrologie) of the Verband Deutsche Nierenzentren
- Keryx
- Japan Agency for Medical Research and Development (AMED)
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Renin-angiotensin-aldosterone system inhibitors (RAASi) are recommended for chronic kidney disease (CKD) patients. In this study, we describe RAASi prescription patterns in the Chronic Kidney Disease Outcomes and Practice Patterns Study (CKDopps) in Brazil, Germany, France, and the United States (US). 5870 patients (mean age 66-72 years; congestive heart failure [CHF] in 11%-19%; diabetes in 43%-54%; serum potassium >= 5 in 20%-35%) were included. RAASi prescription was more common in Germany (80%) and France (77%) than Brazil (66%) and the United States (52%), where the prevalence of prescription decreases particularly in patients with CKD stage 5. In the multivariable regression model, RAASi prescription was least common in the United States and more common in patients who were younger, had diabetes, hypertension, or less advanced CKD. In conclusion, RAASi prescription patterns vary by country, and by demographic and clinical characteristics. RAASi appear to be underused, even among patients with strong class-specific recommendations. Although the reasons for this variation could not be fully identified in this cross-sectional observation, our data indicate that the risk of hyperkalemia may contribute to the underuse of this class of agents in moderate to advanced CKD.
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