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Indicator Details: CKD -5 Increase the Proportion of Adults with Diabetes and Chronic Kidney Disease Who Get ACE Inhibitors or ARBs
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ACE/ARB use in adults with diabetes and CKD has increased from 43.06% in 2001-2004 to 54.83% 2017-2020.

Chart Explanation: 

This graph shows the overall use of ACE inhibitors and ARBs and proportions of individual ACE inhibitor and ARB use in adults with diabetes and CKD, over the years 2001-2004 to 2017-2020.

The survey consists of a standardized in-home interview and a physical examination with blood and urine collected at a mobile examination center (MEC). Here, we examined data from 2001-2002, 2003-2004, 2005-2006, 2007-2008, 2009-2010, 2011-2012, 2013-2014, 2015-2016, 2017-March 2020 NHANES. The estimated glomerular filtration rate (eGFR) was calculated according to the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation for calibrated creatinine (Levey et al., 2009). Serum creatinine was calibrated for 1999-2000 and 2005-2006 participants; no correction was required for calibrated serum creatinine in participants in the 2001-2002, 2003-2004, 2007-2008, 2009-2010, 2011-2012, 2013-2014, and 2015-2016 surveys (Selvin et al., 2007). Albuminuria was defined by urinary albumin-to-creatinine ratio ≥30 mg/g; moderate albuminuria ranges between 30 and 299 mg/g and severe albuminuria is ≥300 mg/g; pregnant women were excluded. For comparisons across the 18-year period 1999-2016, albuminuria was corrected in 1999-2006 to account for differences in the instrumentation and method for urine creatinine starting in 2007. The prevalence of CKD is likely overestimated by single measurements of albuminuria and kidney function (eGFR). In clinical practice, CKD is defined by persistent albuminuria or reduced kidney function for ≥3 months.

Description of Measure

Increase the proportion of adults with diabetes and CKD who get ACE inhibitors or ARBs.

Data Source


Type of Data Source




Healthcare System Data


Regional or National


Demographic Group

Noninstitutionalized U.S. residents aged 18+ years

Definition of CKD

Stage 1, eGFR ≥ 90 ml/min/1.73 m² and presence of single albuminuria; Stage 2, eGFR 60-89 ml/min/1.73 m² and presence of single albuminuria; Stage 3, eGFR 30-59 ml/min/1.73 m²; Stage 4, 15-29 ml/min/1.73 m²; Stage 5, excluded

Glomerular Filtration Rate

Estimated using CKD-EPI equation for calibrated creatinine: eGFR=141 x [min(calibrated serum creatinine in mg/dL) /κ, 1)]α x [max(calibrated serum creatinine in mg/dL/κ, 1)]κ  x 0.993age x (1.018 if female) x (1.159 if NH Black)
κ = 0.7 if female, and 0.9 if male
α = -0.329 if female, and -0.411 if male


Urinary albumin-to-creatinine ratios of 30-299 mg/g (microalbuminuria) and >300 mg/g (macroalbuminuria); pregnant/menstruating women excluded

Primary Data Source Indicator


Primary Indicator Method of Measurement


Limitations of Indicator
Analytic Considerations

Appropriate NHANES survey weights must be used for all analyses;

Suggested Citation:
Centers for Disease Control and Prevention. Chronic Kidney Disease Surveillance System—United States.
website. http://www.cdc.gov/ckd