Prescriptions for angiotensin-converting enzyme inhibitors/angiotensin receptor blockers and monitoring of serum creatinine and potassium in patients with chronic kidney disease.

Angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (ACEIs/ARBs) are commonly used in patients with chronic kidney disease (CKD). We studied the status of ACEI/ARB prescriptions and serum creatinine (Scr) and potassium monitoring in CKD patients. A retrospective observational study was conducted on patients who had at least two sets of Scr data at outpatient visit. Estimated glomerular filtration rate (eGFR) based on the second Scr value was calculated using the Modification of Diet in Renal Disease four-variable equation. CKD was defined and staged according to the National Kidney Foundation Disease Outcomes Quality Initiative Guideline. Patients with diabetes and/or hypertension with an eGFR over 60 mL/min/1.73 m(2) and without proteinuria were defined as the CKD-at-risk group. The percentages and factors associated with ACEI/ARB prescription and Scr and potassium monitoring were calculated and analyzed by logistic regression. Among the 5714 subjects included, ACEIs/ARBs were prescribed to over 50% of patients in the CKD-at-risk group and in CKD stages 1-5. After adjusting for age, sex, potassium level, eGFR, and co-morbidities, the odds ratios for prescriptions of ACEIs/ARBs were 1.66 [95% confidence interval (CI) 1.44-1.91, p < 0.001) and 2.80 (95% CI 2.12-3.70, p < 0.001) in CKD stage 3, and stages 4 and 5, respectively, compared with the reference group (eGFR≥60 mL/min/1.73 m(2)). During the year of ACEI/ARB treatment, Scr was monitored in 91.6% of ACEI/ARB-treated patients, while potassium was monitored in only 38.1%. Renal function status was the independent factor for monitoring of Scr and potassium. In conclusion, prescription of ACEIs/ARBs was common in all stages of CKD. Most patients underwent Scr monitoring, but potassium monitoring was less frequent, and this should be improved in clinical practice.
(Copyright © 2012. Published by Elsevier B.V.)