Overall, 42.6% 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 2022, down from 59.5% in 2006. 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 (54.7% vs. 30.8% in 2022).
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.
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.
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.
VHA national data, using the MedSAS data, MCA prescription data, and the CDW LabChem files.
Patients ≥ 18 years in VHA with at least one outpatient visit within the fiscal year.
2006–2022.
Patients ≥ 18 years with a record of at least one filled prescription for an ACEi or ARB during the specified fiscal year.
Patients ≥ 18 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.
CKD stages 3–5 are defined by estimated glomerular filtration rate (eGFR). Stage 3a: eGFR 45–59 ml/min/1.73 m²; stage 3b: eGFR 30–44 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.
Based on the CKD-EPI (2021) equation for calibrated creatinine: eGFR=142 x [min(serum creatinine in mg/dL) /κ, 1)]**α x [max(serum creatinine/κ, 1)]**-1.20 x 0.9938**age x (1.012 if female). κ = 0.7 if female and 0.9 if male α = -0.241 if female and -0.302 if male ** = raise to the power
Laboratory measurements taken during outpatient appointments.
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.
Hypertension status determined by inpatient or outpatient diagnosis (ICD-9-CM or ICD-10-CM code) or filling an outpatient prescription for antihypertension medication through the VHA pharmacy.
Patients may fill prescriptions outside of the VHA system, which would not be captured in our numerator.
Not all Veterans use the VHA Health System.