Facility variation in utilization of angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers in patients with diabetes mellitus and chronic kidney disease

Am J Manag Care. 2007 Feb;13(2):73-9.


Objective: To evaluate facility-level variation in prescription rates of angiotensin-converting enzyme inhibitor (ACEI) or angiotensin II receptor blocker (ARB) medications for patients with diabetes mellitus (DM) and chronic kidney disease (CKD).

Study design: Retrospective database analysis from 143 Veterans Health Administration facilities.

Methods: Subjects with DM aged 18 to 75 years were identified as having stage 2-4 CKD using estimated glomerular filtration rate (eGFR) based on an index eGFR in 1999 and a subsequent eGFR 90-365 days later. Whether ACEI/ARB medications were prescribed within 1 year after the index eGFR was determined. Variation in facility-level rates was evaluated separately for subjects age <65 years and 65 to 75 years from facilities with more than 50 subjects per age group.

Results: A total of 103 853 subjects had stage 2 CKD; 51 728, stage 3; and 3233, stage 4. However, 25% of facilities had fewer than 50 patients age <65 years with either stage 3 or 4 CKD. The median (range) facility-level prescription rates of ACEI/ARB for stage 2 and combined stage 3-4 CKD were 58.5% (44.3%-71.2%) and 73.3% (51.7%-84.6%), respectively, for subjects age <65 years; and 56.5% (38.1%-71.4%) and 68.4% (51.6%-80.1%), respectively, for subjects aged 65 to 75 years. Spearman rank correlation between facility rankings by age group was 0.72 for stage 2 (139 facilities) and 0.49 for stage 3-4 (111 facilities) (P < .001).

Conclusion: Although ascertainment of prescription rates of ACEI/ARB to CKD patients is feasible using electronic health records, small sample size at the healthcare-system level preclude their utility for public reporting.

Publication types

  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Adult
  • Age Distribution
  • Aged
  • Angiotensin Receptor Antagonists*
  • Angiotensin-Converting Enzyme Inhibitors / therapeutic use*
  • Diabetes Complications / drug therapy*
  • Diabetes Mellitus, Type 2 / drug therapy*
  • Drug Utilization
  • Female
  • Glomerular Filtration Rate
  • Hospitals, Veterans
  • Humans
  • Kidney Failure, Chronic / classification
  • Kidney Failure, Chronic / complications*
  • Kidney Failure, Chronic / drug therapy
  • Male
  • Medical Records
  • Middle Aged
  • Multicenter Studies as Topic
  • Retrospective Studies
  • Severity of Illness Index
  • United States


  • Angiotensin Receptor Antagonists
  • Angiotensin-Converting Enzyme Inhibitors