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ACEi/ARB use among U.S. Veterans with CKD Stages 3-5

ACEi/ARB use among U.S. Veterans with CKD Stages 3-5

Overall, 43.4% of U.S. Veterans with chronic kidney disease (CKD) stages 3–5 filled at least one prescription for either an angiotensin-converting enzyme inhibitor (ACEi) or an angiotensin receptor blocker (ARB) in 2020, down from 58.5% in 2005. Use of ACEi/ARB medications is greater with age, except for those aged ≥ 70 years. Use of ACEi/ARB is higher among CKD patients with diabetes than those without diabetes (54.9% vs. 32.2% in 2020).

Data Source: NATIONAL VA

To view the percentage of ACEi/ARB use among U.S. Veterans with CKD stages 3–5 by risk categories, select from the drop-down menu below. Risk categories include Overall, Age, Sex, Race/Ethnicity, and Diabetes.

ACEi/ARB Use (%), Overall

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Excludes Veterans on dialysis or with a kidney transplant. Data are not adjusted.

VHA is America’s largest integrated health care system, providing care at 171 medical centers and 1,113 outpatient sites. VHA serves over 9 million enrolled Veterans each year. National VHA data were examined for Veterans with at least one outpatient visit during the federal fiscal year (October 1 to September 30). Medical conditions were defined by ICD-9-CM and ICD-10-CM diagnosis codes on at least one outpatient claim.

Description of Measure

Percentage of patients with CKD stages 3–5 that filled at least one prescription for an ACEi or an ARB within the specified fiscal year through the Veterans Health Administration (VHA) pharmacy.

Data Set

Veterans Affairs (VA) National Data, using the MedSAS data, MCA lab and prescription data files.


Patients ≥ 20 years in VHA with at least one outpatient visit within the fiscal year.

Years Included



Patients ≥ 20 years with a record of at least one filled prescription for an ACEi or ARB during the specified fiscal year.


Patients ≥ 20 years with estimated glomerular filtration rate (eGFR) < 60 ml/min/1.73m2 based on a serum creatinine result during the given fiscal year and not on dialysis or a transplant recipient.

Definition of CKD and CKD Stage

CKD is defined based on estimated glomerular filtration rate (eGFR) categories. Stage 3: eGFR 30–59 ml/min/1.73 m², Stage 4: eGFR 15–29 ml/min/1.73 m², Stage 5: eGFR <15 ml/min/1.73 m², not on dialysis or with a kidney transplant.

Estimated glomerular filtration rate (eGFR)

Based on the CKD-EPI equation for calibrated creatinine: eGFR=141 x [min (serum creatinine in mg/dL) /κ, 1)]**α x [max(serum creatinine/κ, 1)]**-1.20 x 0.993**age x (1.018 if female) x (1.159 if a Black person).

κ = 0.7 if female and 0.9 if male
α = -0.329 if female and -0.411 if male
** = raise to the power

Serum Creatinine

Laboratory measurements taken during outpatient appointments.

Drugs in ACEi and ARB classes

ACEi drugs include benazepril, captopril, enalapril, fosinopril, lisinopril, moexipril, perindopril, quinapril, ramipril, and trandolapril.

ARBs include azilsartan, candesartan, eprosartan, irbesartan, losartan, olmesartan, telmisartan, and valsartan.


Diabetes status determined by inpatient or outpatient diagnosis (ICD-9-CM or ICD-10-CM code), outpatient lab test results for HbA1c (≥ 6.5%) or random glucose (≥ 200 mg/dL) or filling an outpatient prescription for diabetes medication through the VHA pharmacy.

Limitations of Indicator

Patients may fill prescriptions outside of the VHA system, which would not be captured in our numerator.

Analytical Considerations

Not all Veterans use the VHA Health System.

References and Sources:
  • Kidney Disease: Improving Global Outcomes (KDIGO) CKD Work Group. KDIGO clinical practice guideline for the evaluation and management of chronic kidney disease. Kidney Int. 2013;3(Suppl 1):1-150.
  • National Kidney Foundation. K/DOQI clinical practice guidelines for chronic kidney disease: evaluation, classification and stratification. Am J Kidney Dis. 2002;39(2)(Suppl 1):S1-S266.

eGFR Formula Disclaimer
At the time of the last data update in summer 2022, the race-free eGFR formula was newly recommended and impact on health outcomes is underway. To avoid inconsistent results caused by different formulae, stakeholders continued using the eGFR formula with race during this transition. Since then, comparisons have been made. The estimates for the current website launch are still based on analyses using the eGFR formula with race, however plan is to use race-free eGFR formula for the next data update and upcoming website launch in fall 2023.