Chronic Illness

Many diabetes patients at high risk for kidney failure are not receiving medication to slow its development

Diabetes is the cause of 45 percent of end-stage renal disease (ESRD), that is, kidney failure, which leads to renal dialysis or kidney transplant. Diabetes patients with clinical risk factors—such as high blood pressure or albuminuria (high levels of the protein albumin in the urine, a sign of kidney disease)—and those who are black, Asian, or Latino are more likely to progress to kidney failure than other people with diabetes. However, a recent study shows that about half of patients in high-risk clinical groups are not receiving angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs) to slow the progression of diabetes to kidney failure. The study was supported in part by the Agency for Healthcare Research and Quality (T32 HS00020).

Targeted efforts to increase use of ACE inhibitors and ARBs could improve quality of care and reduce ESRD incidence both overall and in high-risk ethnic groups, suggests Allison B. Rosen, M.D., M.P.H., of the Harvard School of Public Health. Dr. Rosen and her colleagues examined data on pharmacy dispensing of ACE inhibitors or ARBs to 38,887 diabetes patients who were enrolled with pharmacy benefits in the 2000 Kaiser Permanente Northern California Diabetes Registry. Forty-one percent of the group had both hypertension and albuminuria, 30 percent had hypertension alone, and 12 percent had albuminuria alone. Also, 14 percent of the patients were black, 11 percent were Latino, 13 percent were Asian, and 63 percent were white.

The majority of eligible patients (61 percent) received indicated ACE inhibitor or ARB therapy in 2000. An ACE inhibitor or ARB was dispensed to 74 percent of patients with both hypertension and albuminuria, but this treatment was dispensed to only 64 percent of those with hypertension alone and 54 percent of those with albuminuria alone. An ACE inhibitor or ARB was dispensed to 61 percent of whites, 63 percent of blacks, 59 percent of Latinos, and 60 percent of Asians. Among those with albuminuria alone, blacks were significantly less likely than whites to receive either medication (47 vs. 56 percent). No other ethnic disparities were found.

See "Use of angiotensin-converting enzyme inhibitors and angiotensin receptor blockers in high-risk clinical and ethnic groups with diabetes," by Dr. Rosen, Andrew J. Karter, Ph.D., Jennifer Y. Liu, M.P.H., and others, in the Journal of General Internal Medicine 19, pp. 669-675, 2004.

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