Overall, ACEI/ARB use increased from about 25% to 40% among American Indians with CKD from 1993-1995 to 1998-1999
American Indians with CKD were about twice as likely to be treated with ACEIs/ARBs as their counterparts without CKD
Chart Explanation: Overall, ACEI/ARB use increased from about 25% to 40% among American Indians with CKD from 1993-1995 to 1998-1999. Those with CKD were about twice as likely to be treated with ACEIs/ARBs as their counterparts without CKD. Those with diabetes were also more likely to be treated with ACEIs/ARBs than those without diabetes, in both time periods.
The Strong Heart Study consisted of several components and three study exams (baseline, 1989-1992; second exam, 1993-1995; and third exam, 1998-1999), followed by morbidity and mortality surveillance of 4,500 tribal participants. Strong Heart enrolled men and women aged 45-74 at baseline from 13 American Indian tribes/communities in Arizona, Oklahoma, and the Dakotas. A total of 3,431 Strong Heart participants had baseline information on both kidney function (eGFR) and albuminuria (albumin:creatinine ratio) and information on angiotensin-converting enzyme inhibitors and angiotensin receptor blockers (ACEIs/ARBs) at exams 2 and 3. CKD stages were defined by ACR > 30mg/g and eGFR in ml/min/1.73 m2 by the 4-parameter MDRD Study equation.
| Field | Data |
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| Description of Measure | Prevalence of ACE inhibitor/ARB use
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| Data Source | Strong Heart Study
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| Type of Data Source | Private
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| Data Set | SHS
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| Health Care System Data | No
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| Regional or National? | National
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| Demographic Group | American Indians aged 45-74 from 13 tribes/communities
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| Numerator | Number of participants who reported using ACE inhibitors or ARBs at second and third exams
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| Denominator | All participants at second and third exam
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| Definition of CKD | No CKD, eGFR >90 ml/min/1.73 m2 & albumin:creatinine ratio <30 mg/g
Stage 1, eGFR >90 ml/min/1.73 m2 & albumin:creatinine ratio >30 mg/g
Stage 2, eGFR 60-89 ml/min/1.73 m2 & albumin:creatinine ratio >30 mg/g
Stages 3-5, eGFR <60 ml/min/1.73 m2
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| Glomerular filtration rate | Calculated by MDRD-4 Study equation
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| Proteinuria | Spot urine albumin:creatinine ratio
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| Primary Data Source Indicator | Percentage of participants self-reporting ACE inhibitor or ARB use (confirmed by interviewer)
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| Primary Indicator Method of Measurement | Questionnaire
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| Frequency of Measurement (Primary) | Twice
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| U.S. Region Covered by Primary Variable | Arizona, Oklahoma, and the Dakotas
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| Period Currently Available | 1993–1999 |
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| Pending Data | Possible continued passive follow-up only
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| Additional Data Items of Interest | Age, gender, diabetes, hypertension
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| Limitations of Indicator | Possible misclassification of medication use due to non-adherence
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| Analytical Considerations | Analysis performed by SHS investigators; denominators for each study exam and indicator must be defined properly
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