#4494 DRUG UTILIZATION FOLLOWING INCIDENT CHRONIC KIDNEY DISEASE: AN OBSERVATIONAL STUDY IN THE UNITED STATES AND JAPAN

Abstract Background and Aims Chronic kidney disease (CKD) affects >840 million individuals worldwide and is a leading cause of morbidity and mortality. Complications include cardiorenal outcomes (e.g. end stage kidney disease and heart failure (HF)) and premature death, which may be preventable with early identification and appropriate treatment of CKD. Treatment of CKD with renin-angiotensin-system inhibitors (RASi) has been the main recommendation of guidelines in the past 20 years, but prescribing rates remain low and discontinuation rates remain high, particularly after adverse events like hyperkalaemia episodes. This study aims to describe RASi utilization following incident CKD. Method Adult patients with incident CKD in the United States (US; OPTUM Market Clarity until 31 March 2022) and Japan (Medical Data Vision until 28 February 2022) from 1 January 2016 onwards were included. CKD was defined as any of the following: a UACR measure of ≥30 mg/g, two estimated glomerular filtration rate (eGFR) ≥90 days apart of which the second was ≤75 ml/min/1.73 m2, or a CKD diagnosis code. Patients were included if they had an eGFR ≤60 ml/min/1.73 m2. Patients with ongoing RASi treatment at index, a history of diabetes, heart failure or dialysis were excluded. Results A total of 66,375 incident CKD patients were identified in the US (n = 32,158) and Japan (n = 34,217). Mean age was 66 and 78 years in the US and Japan, respectively, and about half of the patients were female. Mean eGFR was 48 and 40 ml/min/1.73 m2 in the US and Japan, respectively. Approximately 30% of patients had cardiovascular disease, but only 13% (US) and less than 5% (Japan) were prescribed cardiovascular preventive drugs (e.g. statins and low dose aspirin). During a 1-year follow-up after the incident CKD index date, only 15% and 5% had been initiated on RASi in the US and Japan, respectively (Figure 1). Time to RASi initiation was shorter among those with a CKD diagnosis vs those without a diagnosis (US: 15 vs 19 months, Japan: 6 vs 11 months). Of those who initiated treatment, approximately 50% discontinued within one year (Figure 1). Results for initiation and discontinuation were similar across CKD stages in both countries. Conclusion In the US and Japan, initiation of RASi was remarkably low among newly identified CKD patients, and discontinuation of initiated treatment was substantial. Given that most patients with CKD benefit from multi-drug therapy (RASi + SGLT2i) for slowing CKD progression and reduction of adverse events, efforts to increase prescribing and adherence are needed.

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