Underuse of ACE inhibitors and angiotensin II receptor blockers among patients with diabetic nephropathy in Taiwan

Yeh, Hseng-Long; Huang, Li-Ying; Su, Sheng‐Fang; Yang, Ming‐Chin; Wang, Ting‐Chung

doi:10.1016/j.healthpol.2010.11.010

Cited by 3 publications

(2 citation statements)

References 21 publications

(19 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In other studies, roughly 50% of patients with indications for RAAS inhibition have been reported as not taking these medications. 17–19 Our results suggest that strategies maximizing RAAS inhibition such as dietary management of hyperkalemia may be underutilized. We observed low utilization of kayexalate, which may be related to concerns about potential colonic necrosis risk that were issued on a black box warning in January 2011 by the Federal Drug Administration.…”

Section: Discussionmentioning

confidence: 94%

Antihypertensive Medications and the Prevalence of Hyperkalemia in a Large Health System

et al. 2016

View full text Add to dashboard Cite

Little is known about the frequency and patterns of hyperkalemia in clinical settings. We evaluated the association between baseline antihypertensive medications that may affect potassium levels (angiotensin converting enzyme inhibitors (ACEIs), angiotensin receptor blockers (ARBs), beta-blockers, loop/thiazide diuretics, and potassium-sparing diuretics) and hyperkalemia, defined by potassium >5 mEq/L and >5.5 mEq/L, over a 3-year time period in 194,456 outpatients in the Geisinger Health System, as well as actions taken after an episode of hyperkalemia. The proportions of patients with 0, <2, 2–4, and ≥4 potassium measurements per year were 20%, 58%, 16%, and 6%. Potassium levels >5 mEq/L and >5.5 mEq/L occurred in 10.8% and 2.3% of all patients over the 3-year period; among patients with ≥4 measurements per year, corresponding values were 39.4% and 14.6%. Most cases of hyperkalemia occurred only once during follow-up. The antihypertensive medication class most strongly associated with hyperkalemia was ACEIs. Among patients with a measurement of potassium >5.5 mEq/L, only 24% were seen by a nephrologist and 5.2% were seen by a dietician during the 3-year period. Short-term actions after a potassium measurement >5.5 mEq/L included emergency room visit (3.1% within 7 days), re-measurement of potassium (44.3% with 14 days), and change in a potassium-altering medication (26.4% within 60 days). The most common medication changes were discontinuation/dose reduction of an ACEI/ARB or potassium-sparing diuretic, which occurred in 29.1% and 49.6% of persons taking these medications, respectively. In conclusion, hyperkalemia is common. Future research may enable optimal RAAS inhibitor use with improved management of hyperkalemia.

show abstract

Section: Discussionmentioning

confidence: 94%

Antihypertensive Medications and the Prevalence of Hyperkalemia in a Large Health System

et al. 2016

View full text Add to dashboard Cite

show abstract

“…Rosen et al reported that 54% of patients with albuminuria, 64% of patients with hypertension, and 74% of patients with both conditions were prescribed ACEI/ARB in 2000 [ 25 ]. A study from Taiwan also showed that over 50% of patients in the CKD at-risk group (defined as patients with diabetes and/or hypertension but no proteinuria) and in CKD stages 1–5 were prescribed ACEI/ARB [ 26 ]. From these studies, it seems that the managements of diabetes with kidney damage in these areas are sub-optimized in some patients based on current evidences.…”

Section: Discussionmentioning

confidence: 99%

ACEI/ARB Underused in Patients with Type 2 Diabetes in Chinese Population (CCMR-3B Study)

Xie

Hao

et al. 2015

PLoS ONE

View full text Add to dashboard Cite

ObjectiveIn patients with diabetic kidney disease, it is well documented that RAS blockade is associated with an improved outcome. This observational, multicenter study examined the “real-world” use of ACEI/ARB in patients with type 2 diabetes (T2DM) in China.MethodData from the China Cardiometabolic Registries on blood pressure, blood lipid and blood glucose in Chinese T2DM patients (CCMR-3B) were used for the present study. Consecutive outpatients with T2DM for more than 6 months were recruited to this non-interventional, observational, cross-sectional study. Albuminuria was defined as urine albumin creatinine ratio (ACR) ≥ 30mg/g.ResultsA total of 25,454 outpatients with T2DM from 6 regions in China were enrolled, 47.0% were male, and 59.8% had hypertension. ACR was measured in 6,383 of these patients and 3,231 of them ≥ 30mg/L. Among patients with hypertension, 73.0% were on antihypertensives, and 39.7% used ACEI/ARB. Of the 2,157 patients with hypertension and albuminuria, only 48.3% used ACEI/ARB. Among the non-hypertensive patients with albuminuria, ACEI/ARB usage was < 1%. Multivariate analysis revealed that comorbidities, region, hospital tier, physician specialty and patient’s educational level were associated with ACEI/ARB use.ConclusionIn T2DM with hypertension and albuminuria in China, more than half of them were not treated with ACEI/ARB. This real world evidence suggests that the current treatment for patients with diabetes coexisting with hypertension and albuminuria in China is sub-optimal.

show abstract

Evaluating the Prescription of Angiotensin-Converting Enzyme Inhibitors or Receptor Blockers in Patients with Diabetes in Jordan

2017

View full text Add to dashboard Cite

Underuse of ACE inhibitors and angiotensin II receptor blockers among patients with diabetic nephropathy in Taiwan

Cited by 3 publications

References 21 publications

Antihypertensive Medications and the Prevalence of Hyperkalemia in a Large Health System

Antihypertensive Medications and the Prevalence of Hyperkalemia in a Large Health System

ACEI/ARB Underused in Patients with Type 2 Diabetes in Chinese Population (CCMR-3B Study)

Evaluating the Prescription of Angiotensin-Converting Enzyme Inhibitors or Receptor Blockers in Patients with Diabetes in Jordan

Contact Info

Product

Resources

About