[Prescription of renin-angiotensin-aldosterone system blockers in patients with stage 3 chronic kidney disease].
Prescripción de fármacos bloqueadores del sistema renina angiotensina en pacientes con enfermedad renal crónica etapa 3 en atención primaria de salud.
Adult
Aged
Aged, 80 and over
Albuminuria
/ urine
Angiotensin-Converting Enzyme Inhibitors
/ administration & dosage
Creatinine
/ blood
Diabetes Mellitus
/ drug therapy
Disease Progression
Drug Therapy, Combination
Enalapril
/ administration & dosage
Female
Humans
Hypertension
/ drug therapy
Losartan
/ administration & dosage
Male
Middle Aged
Proteinuria
/ urine
Renal Insufficiency, Chronic
/ drug therapy
Renin-Angiotensin System
Treatment Adherence and Compliance
/ psychology
Journal
Revista medica de Chile
ISSN: 0717-6163
Titre abrégé: Rev Med Chil
Pays: Chile
ID NLM: 0404312
Informations de publication
Date de publication:
Feb 2019
Feb 2019
Historique:
received:
03
08
2018
accepted:
04
03
2019
entrez:
17
5
2019
pubmed:
17
5
2019
medline:
28
7
2019
Statut:
ppublish
Résumé
To reduce the progression of chronic kidney disease (CKD) and cardiovascular risk, the guidelines recommend the blockade of the renin-angiotensin-aldosterone system (RAAS) in patients with proteinuria. To assess the frequency of enalapril or losartan use in diabetics or hypertensive patients with stage 3 CKD. Review of clinical records of patients with CKD in an urban primary care clinic. We identified 408 subjects aged 40 to 98 years (66% women) with stage 3 CKD. Sixty six percent had only hypertension and 34% were diabetic with or without hypertension. Seventy four percent received RAAS blockers (52% used enalapril, 45% losartan and 2% both medications). RAAS blockers were used in 70% of hypertensive and 78% of diabetic patients. The prescription in hypertensive diabetics with microalbuminuria was lower than in those without microalbuminuria (72% vs 87%, p < 0.05), but the opposite occurred in pure hypertensive patients with and without microalbuminuria (88% vs 69%, p < 0.05). There were no significant differences in blood pressure levels, microalbuminuria or serum potassium levels between RAAS blocker users and non-users. No differences were observed either between enalapril and losartan users. The adherence to clinical guidelines is insufficient and users of the recommended drugs did not achieve the expected goals.
Sections du résumé
BACKGROUND
BACKGROUND
To reduce the progression of chronic kidney disease (CKD) and cardiovascular risk, the guidelines recommend the blockade of the renin-angiotensin-aldosterone system (RAAS) in patients with proteinuria.
AIM
OBJECTIVE
To assess the frequency of enalapril or losartan use in diabetics or hypertensive patients with stage 3 CKD.
MATERIAL AND METHODS
METHODS
Review of clinical records of patients with CKD in an urban primary care clinic.
RESULTS
RESULTS
We identified 408 subjects aged 40 to 98 years (66% women) with stage 3 CKD. Sixty six percent had only hypertension and 34% were diabetic with or without hypertension. Seventy four percent received RAAS blockers (52% used enalapril, 45% losartan and 2% both medications). RAAS blockers were used in 70% of hypertensive and 78% of diabetic patients. The prescription in hypertensive diabetics with microalbuminuria was lower than in those without microalbuminuria (72% vs 87%, p < 0.05), but the opposite occurred in pure hypertensive patients with and without microalbuminuria (88% vs 69%, p < 0.05). There were no significant differences in blood pressure levels, microalbuminuria or serum potassium levels between RAAS blocker users and non-users. No differences were observed either between enalapril and losartan users.
CONCLUSIONS
CONCLUSIONS
The adherence to clinical guidelines is insufficient and users of the recommended drugs did not achieve the expected goals.
Identifiants
pubmed: 31095165
pii: S0034-98872019000200173
doi: 10.4067/s0034-98872019000200173
pii:
doi:
Substances chimiques
Angiotensin-Converting Enzyme Inhibitors
0
Enalapril
69PN84IO1A
Creatinine
AYI8EX34EU
Losartan
JMS50MPO89
Types de publication
Journal Article
Langues
spa