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Home > Quality of Care > Use of Medications in CKD > Trends in ACEi/ARB use among Commercially Insured Patients with Diagnosed CKD Stages 3–5

Trends in ACEi/ARB use among Commercially Insured Patients with Diagnosed CKD Stages 3–5

Trends in ACEi/ARB use among Commercially Insured Patients with Diagnosed CKD Stages 3–5

In 2020, 54.9% of patients with diagnosed 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), compared to 62.3% in 2006. The use of ACEi/ARB medications generally increased with age, except for patients ≥ 70 years old. Use of ACEi/ARB was 62.0% among CKD patients with diabetes and 47.5% in those without diabetes in 2020.

Data Source: Clinformatics Commercial

To view the use of ACEi/ARBs by risk categories, select from the drop-down menu below. Risk categories include: Overall, Age Category, Sex, Race/Ethnicity, Diabetes, and Hypertension.


ACEi/ARB use (%), Overall
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Data includes CKD stages 3–5. Data are not adjusted.

Clinformatics data sets provide paid medical and prescription claims and enrollment information for participants in commercial insurance plans and Medicare Advantage plans. The sample was limited to those enrolled in their health plan for all 12 months of the calendar year. Chronic kidney disease (CKD) and diabetes are defined using the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM), or Tenth Revision (ICD-10-CM) diagnosis codes. Outpatient pharmacy records of prescriptions filled for patients were examined for drugs in the sodium-glucose cotransporter-2 (SGLT2) inhibitors class. For inclusion in analyses, beneficiaries had to be in the enrollment file. To define CKD, diabetes, or hypertension, at least one inpatient or two outpatient claims were used.

FieldData
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 calendar year in Clinformatics Commercial population.

Data Set

Clinformatics Commercial from Optum Clinformatics Data Mart Database (Optum Insight, Eden Prairie, MN)

Population

Privately insured patients aged ≥ 20 years with at least one inpatient or two outpatient claims during the calendar year.

Years Included

2006–2020.

Numerator

Patients aged ≥ 20 years with a prescription for an ACEi/ARB identified by generic name and National Drug Code (NDC).

Denominator

Patients aged 20–64 years enrolled in Clinformatics Commercial insurance and diagnosed with CKD Stages 3–5.

Definition of CKD Stages 3–5

ICD-9-CM and ICD-10-CM diagnosis codes shown below.

ICD-10-CM Codes for CKD Stages 3–5

N17.3, N17.4, N17.5.

ICD-9-CM Codes for CKD Stages 3–5

585.3, 585.4, 585.5.

ACEi/ARB Drugs

ACEi/ARBs are identified by generic name and American Hospital Formulary Service Classification System (AHFSCS) from National Drug Code (NDC): 24084404 or 24084408 or 243204xx or 243208xx.

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.

Limitations of Indicator

As a measure of prevalence, the use of ICD-9-CM or ICD-10-CM diagnosis codes will underestimate CKD.

Analytical Considerations

Consideration must be taken in comparisons of ICD code-based definitions of CKD.


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