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Indicator Details — Native Americans: Use of Angiotensin-converting Enzyme Inhibitors and Angiotensin Receptor Blockers by CKDa
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Footnotes:
a P<0.001 for all subgroup comparisons of CKD vs. no CKD.





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.
FieldData
Description of MeasurePrevalence of ACE inhibitor/ARB use
Data SourceStrong Heart Study
Type of Data SourcePrivate
Data SetSHS
Health Care System DataNo
Regional or National?National
Demographic GroupAmerican Indians aged 45-74 from 13 tribes/communities 
NumeratorNumber of participants who reported using ACE inhibitors or ARBs at second and third exams
DenominatorAll participants at second and third exam
Definition of CKDNo 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 
Glomerular filtration rateCalculated by MDRD-4 Study equation
ProteinuriaSpot urine albumin:creatinine ratio
Primary Data Source IndicatorPercentage of participants self-reporting ACE inhibitor or ARB use (confirmed by interviewer)
Primary Indicator Method of MeasurementQuestionnaire
Frequency of Measurement (Primary)Twice
U.S. Region Covered by Primary VariableArizona, Oklahoma, and the Dakotas
Period Currently Available1993–1999
Pending DataPossible continued passive follow-up only
Additional Data Items of InterestAge, gender, diabetes, hypertension
Limitations of IndicatorPossible misclassification of medication use due to non-adherence
Analytical ConsiderationsAnalysis performed by SHS investigators; denominators for each study exam and indicator must be defined properly

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