A Systematic Review Of International Policies, Barriers, And Strategies To Increase Peritoneal Dialysis Adoption

Abstract

A 1 -A 3 1 8 A133 eficiaries who had a diagnosis of hypertension and CKD, aged 67 and above and continuously enrolled in Medicare Part D from 2008 to 2013 are included. Baseline characteristics examined using a two year lookback period. Adherence to ACEIs, ARBs and other blood pressure/ lipid lowering agents was measured using proportion of days covered (PDC). Multivariate Cox regression models were used to assess the association between medication adherence and progression to end stage renal disease (ESRD) and death. Results: A total of 115,769 hypertensive patients with CKD were included. Approximately 2.5% of them developed ESRD and 57.5% of them died during 2008-2013. Adherence to ACEIs and ARBs was associated with a significant decreased hazard of developing ESRD (Hazard Ratio: 0.29 95%CI [0.25-0.33] p< 0.0001; 0.49 95% CI [0.42, 0.57] p< 0.0001, respectively) after adjusting for demographic and clinical confounders. Patients with increased use of ACEIs and ARBs had reduced risk of death (Hazard Ratio: 0.76 95%CI [0.74-0.78] p< 0.0001; 0.64 95% CI [0.62, 0.66] p< 0.0001, respectively). Increased adherence to diuretics and statins were associated with lower ESRD and mortality risk, while calcium channel blockers and beta blockers were associated with increased ESRD risk and lower mortality risk. ConClusions: Increased adherence to ACEIs and ARBs for elderly patients diagnosed with hypertensive CKD is associated with delay in CKD progression and lower mortality risk. These findings could have significant implications for hypertension management in this population.