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©The Author(s) 2024.
World J Clin Cases. Jun 16, 2024; 12(17): 3061-3075
Published online Jun 16, 2024. doi: 10.12998/wjcc.v12.i17.3061
Published online Jun 16, 2024. doi: 10.12998/wjcc.v12.i17.3061
Table 1 Characteristics of chronic kidney disease patients with or without renin-angiotensin system inhibitors prescriptions, n (%)
| Characteristic | All | No RASI | RASI | P value |
| Patients | 35090 | 25047 | 10043 | |
| Beijing patients | 6756 (19.3) | 5045 (20.1) | 1711(17.0) | |
| Guideline-recommend patients | 18919 (53.9) | 11673 (61.7) | 7246 (72.2) | < 0.001 |
| Calendar year | < 0.001 | |||
| 2010–2011 | 6679 (19.0) | 5785 (23.1) | 894 (8.9) | < 0.001 |
| 2012–2013 | 7487 (21.3) | 5104 (20.4) | 2383 (23.7) | |
| 2014–2015 | 7205 (20.5) | 4606 (18.4) | 2599 (25.9) | |
| 2016–2017 | 6770 (19.3) | 4503 (18.0) | 2267 (22.6) | |
| 2018–2019 | 6949 (19.8) | 5049 (20.2) | 1900 (18.9) | |
| Age ≥ 60 yr | 11581 (33.0) | 7688 (76.6) | 2355 (23.4) | < 0.001 |
| Men | 21803 (62.1) | 15493 (61.9) | 6310 (62.8) | |
| Ethnic group | ||||
| Han Chinese | 31743 (90.5) | 22686 (90.6) | 9057 (90.2) | |
| BMI (kg/m2) | 24.74 (22.18, 27.4406) | 24.44 (21.91, 27.12) | 25.48 (28.26, 22.99) | |
| Age, yr | 50.33 ± 16.924 | 51.15 ± 17.097 | 46.97 ± 15.760 | < 0.001 |
| Systolic blood pressure (mmHg) | 138 ± 26 | 140 ± 18 | 135 ± 42 | |
| Diastolic blood pressure (mmHg) | 79 ± 12 | 77 ± 14 | 82 ± 9 | |
| Blood glucose (mmol/L) | 8.1 ± 4.3 | 7.9 ± 4.1 | 8.5 ± 5.1 | |
| Hemoglobin (g/dL) | 110 ± 25.6 | 111.4 ± 27 | 107.3 ± 26.2 | |
| Serum phosphorus (mmol/L) | 1.7 ± 0.3 | 1.1 ± 0.3 | 1.4 ± 0.4 | |
| CO2 (mmol/L) | 22.7 ± 3.6 | 23.8 ± 2.5 | 20.4 ± 4.6 | |
| Serum potassium (mmol/L) | 4.3 ± 0.7 | 4.1 ± 0.6 | 4.8 ± 0.9 | |
| Serum creatinine (mg/dL) | 2.4 (1.1, 3.2) | 2.2 (1.1, 3.0) | 2.8 (1.4, 6.2) | |
| Cholesterol (mmol/L) | 4.50 (3.7000, 5.5500) | 4.7000 (3.9300, 5.8200) | 4.3900 (3.6000, 5.41000) | |
| Admitting department | < 0.001 | |||
| Department of Nephrology | 18072 (51.5) | 10669 (42.6) | 7403 (73.7) | |
| Department of Cardiology | 4460 (12.7) | 3233 (12.9) | 1227 (12.2) | |
| Department of Endocrinology | 2306 (6.6) | 1504 (6) | 802 (8.0) | |
| Department of Neurology | 343 (1.0) | 279 (1.1) | 64 (0.6) | |
| Department of Respiratory | 497 (1.4) | 462 (1.8) | 35 (0.3) | |
| Surgery department | 4192 (11.9) | 4135 (16.5) | 57 (0.6) | |
| Others | 5220 (14.9) | 5765 (19) | 455 (4.5) | |
| Cause of CKD | ||||
| Glomerulonephritis | 14127 (40.3) | 2954 (31.8) | 6173 (61.5) | < 0.001 |
| IgA nephropathy | 4153 (11.8) | 2050 (8.2) | 2103 (20.9) | < 0.001 |
| Diabetic kidney disease | 4150 (11.8) | 2696 (10.8) | 1454 (14.5) | < 0.001 |
| Hypertensive nephropathy | 1800 (5.1) | 1004 (4.0) | 796 (7.9) | < 0.001 |
| Others | 16769 (47.7) | 12409 (49.5) | 4340 (43.3) | < 0.001 |
| Medical history | ||||
| Hypertension | 20514 (58.5) | 13533 (54) | 6981 (69.5) | < 0.001 |
| Diabetes mellitus | 9949 (28.4) | 6892 (27.5) | 3057 (30.4) | < 0.001 |
| Coronary heart disease | 5728 (16.3) | 4244 (16.9) | 1484 (14.8) | < 0.001 |
| Atrial fibrillation | 1050 (3) | 836 (3.3) | 214 (2.1) | < 0.001 |
| Heart failure | 2879 (8.2) | 2306 (9.2) | 573 (5.7) | < 0.001 |
| Myocardial infarction | 687 (2) | 527 (2.1) | 160 (1.6) | 0.002 |
| Stroke | 1440 (4.1) | 1116 (4.5) | 324 (3.2) | < 0.001 |
| Peripheral arterial disease | 1074 (3.1) | 678 (2.7) | 396 (3.9) | < 0.001 |
| Hyperlipidemia | 3423 (9.8) | 2166 (8.6) | 1257 (12.5) | < 0.001 |
| Acute kidney injury | 6804 (19.4) | 5740 (22.9) | 1064 (10.6) | < 0.001 |
| Systolic blood pressure (mmHg) | < 0.001 | |||
| ≥ 140 | 15467 (44.1) | 10701 (42.7) | 4766 (47.5) | |
| 120 ≤ SBP < 140 | 6403 (18.3) | 4921 (19.6) | 1482 (14.8) | |
| 90 ≤ SBP < 120 | 13002 (37.1) | 3781 (37.6) | 9221 (36.8) | |
| < 90 | 218 (0.6) | 14 (0.1) | 204 (0.8) | |
| Diastolic blood pressure (mmHg) | < 0.001 | |||
| ≥ 90 | 10519 (30.0) | 6797 (27.1) | 3722 (37.1) | |
| 60 ≤ DBP < 90 | 23365 (66.6) | 17231 (68.8) | 6134 (61.1) | |
| < 60 | 1206 (3.4) | 1019 (4.1) | 187 (3.4) | |
| Staging of CKD | < 0.001 | |||
| G1–2 | 13607 (38.8) | 8592 (34.3) | 5015 (49.9) | |
| G3 | 9420 (26.8) | 6305 (25.2) | 3115 (31) | |
| G4 | 4568 (13) | 3684 (14.7) | 884 (8.8) | |
| G5 | 7495 (21.4) | 6466 (25.8) | 1029 (10.2) | |
| Hemoglobin (g/L) | < 0.001 | |||
| ≥ 120 | 18113.0 | 11645 (46.5) | 6468 (64.5) | |
| 100 ≤ HB < 120 | 8402.0 | 6324 (25.3) | 2078 (20.7) | |
| 70 ≤ HB< 100 | 7201.0 | 5932 (23.7) | 1269 (12.6) | |
| < 70 | 1374.0 | 1146 (4.6) | 228 (2.3) | |
| CO2 < 22 (mmol/L) | 7314 (20.8) | 5380 (21.5) | 1934 (19.3) | < 0.001 |
| Serum potassium (mmol/L) | < 0.001 | |||
| < 5.5 | 33555 (97.5) | 23749 (97.1) | 9806 (98.6) | |
| 5.5-6.0 | 592 (1.7) | 494 (2.0) | 98 (1.0) | |
| > 6.0 | 257 (0.7) | 216 (0.9) | 41 (0.4) | |
| Dipstick test positive | 25806 (73.5) | 17158 (68.5) | 8648 (86.1) | < 0.001 |
| Albuminuria | 21905 (62.43) | 13744 (54.87) | 8161 (37.3) | < 0.001 |
| A1 | 1228 (5.6) | 919 (3.7) | 309 (3.1) | |
| A2 | 3416 (15.6) | 2167 (8.7) | 1249 (12.4) | |
| A3 | 17262 (78.8) | 10658 (42.6) | 6603 (65.7) | |
| Unmeasured LVEF | 32981 (94.0) | 9531 (94.9) | 23450 (93.6) | < 0.001 |
| Medication use | ||||
| Calcium channel blocker | 9636 (27.5) | 5540 (22.1) | 4096 (40.8) | < 0.001 |
| Beta-blocker | 6193 (17.6) | 3679 (14.7) | 2514 (25) | < 0.001 |
| Diuretics | 3469 (9.9) | 1975 (7.9) | 1494 (14.9) | < 0.001 |
| Kidney replacement therapy | 1177 (3.4) | 728 (2.9) | 449 (4.5) | < 0.001 |
| Hemodialysis | 726 (2.1) | 464 (1.9) | 262 (2.6) | < 0.001 |
| Peritoneal dialysis | 494 (1.4) | 285 (1.1) | 209 (2.1) | < 0.001 |
Table 2 Characteristics of guideline-recommended chronic kidney disease patients with or without renin-angiotensin system inhibitors prescriptions in different years, n (%)
| Characteristic | 2010-2011 | 2012-2013 | 2014-2015 | 2016-2017 | 2018-2019 | P value | ||||||||||
| All | No RASI | RASI | All | No RASI | RASI | All | No RASI | RASI | All | No RASI | RASI | All | No RASI | RASI | ||
| Patients | 3518 (18.6) | 636 (8.8) | 2882 (24.7) | 4306 (22.8) | 1798 (24.8) | 2508 (21.5) | 3876 (20.5) | 1848 (25.5) | 2028 (17.4) | 3291 (17.4) | 1512 (20.9) | 1779 (15.2) | 3928 (20.8) | 1452 (20.0) | 2476 (21.2) | < 0.001 |
| Age ≥ 60 yr | 722 (20.5) | 100 (15.7) | 622 (21.6) | 934 (21.7) | 323 (18.0) | 611 (24.4) | 886 (22.9) | 315 (17.0) | 571 (28.2) | 872 (26.5) | 347 (22.9) | 525 (29.5) | 1082 (27.5) | 322 (22.2) | 760 (30.7) | < 0.001 |
| Male | 2101 (59.7) | 393 (61.8) | 1708 (59.3) | 2552 (59.3) | 1079 (60.0) | 1473 (58.7) | 2335 (60.2) | 1131 (61.2) | 1204 (59.4) | 2048 (62.2) | 954 (63.1) | 1094 (61.5) | 2513 (64.0) | 911 (62.7) | 1602 (64.75) | 0.172 |
| Admitting department | < 0.001 | |||||||||||||||
| Department of Nephrology | 2540 (72.2) | 493 (77.5) | 2047 (71.0) | 3186 (74.0) | 1452 (80.8) | 1734 (69.1) | 2779 (71.7) | 1506 (81.5) | 1273 (62.8) | 2350 (71.4) | 1196 (79.1) | 1154 (64.9) | 2869 (73.0) | 1153 (79.4) | 1716 (69.3) | |
| Department of Cardiology | 171 (4.9) | 21 (3.3) | 150 (5.2) | 245 (5.7) | 99 (5.5) | 146 (5.8) | 232 (6.0) | 83 (4.5) | 149 (7.3) | 211 (6.4) | 78 (5.2) | 133 (7.5) | 271 (6.9) | 88 (6.1) | 183 (7.4) | |
| Department of endocrinology | 372 (10.6) | 78 (12.3) | 294 (10.2) | 401 (9.3) | 176 (9.8) | 225 (9.0) | 397 (10.2) | 170 (9.2) | 227 (11.2) | 322 (9.8) | 157 (10.4) | 165 (9.3) | 332 (8.5) | 124 (8.5) | 208 (8.4) | |
| Surgery department | 42 (1.2) | 5 (0.8) | 37 (1.3) | 42 (1.0) | 1 (0.1) | 41 (1.6) | 68 (1.8) | 2 (0.1) | 66 (3.3) | 76 (2.3) | 5 (0.3) | 71 (4.0) | 9 (0.6) | 9 (0.6) | 73 (2.9) | |
| Others | 393 (11.17) | 39 (6.13) | 354 (12.28) | 432 (10.03) | 70 (3.9) | 362 (14.4) | 400 (10.3) | 87 (4.7) | 313 (15.4) | 332 (10.1) | 76 (5.0) | 256 (14.4) | 24 (1.7) | 78 (5.4) | 296 (12.0) | |
| Glomerulonephritis | 1987 (56.5) | 403 (63.4) | 1584 (55.0) | 2559 (59.4) | 1216 (67.6) | 1343 (53.5) | 2333 (60.2) | 1375 (74.4) | 958 (47.2) | 1873 (56.9) | 1056 (69.8) | 817 (45.9) | 2281 (58.1) | 1041 (71.7) | 1240 (50.1) | < 0.001 |
| IgA nephropathy | 668 (19.0) | 178 (28.0) | 490 (17.0) | 763 (17.7) | 467 (26.0) | 296 (11.8) | 651 (16.8) | 438 (23.7) | 213 (10.5) | 527 (16.0) | 315 (20.8) | 212 (11.9) | 620 (15.8) | 296 (20.4) | 324 (13.1) | < 0.001 |
| Diabetic kidney disease | 641 (18.2) | 136 (21.4) | 505 (17.5) | 680 (15.8) | 320 (17.8) | 360 (14.4) | 581 (15.0) | 261 (14.1) | 320 (15.8) | 550 (16.7) | 241 (15.9) | 309 (17.4) | 738 (18.8) | 275 (18.9) | 463 (18.7) | 0.654 |
| Hypertensive nephropathy | 256 (7.3) | 43 (6.8) | 213 (7.4) | 384 (8.9) | 186 (10.3) | 198 (7.9) | 197 (5.1) | 137 (7.4) | 60 (3.0) | 140 (4.3) | 78 (5.2) | 62 (3.5) | 495 (12.6) | 247 (17.0) | 248 (10.0) | < 0.001 |
| Medical history | ||||||||||||||||
| Diabetes mellitus | 1051 (29.9) | 202 (31.8) | 849 (29.5) | 1252 (29.1) | 559 (31.1) | 693 (27.6) | 1090 (33.1) | 488 (32.3) | 602 (33.8) | 1360 (34.6) | 484 (33.3) | 876 (35.4) | 1195 (30.4) | 536 (36.9) | 659 (26.6) | 0.770 |
| Hypertension | 2261 (64.3) | 430 (67.6) | 1831 (63.5) | 2723 (63.2) | 1261 (70.1) | 1462 (58.3) | 2405 (62.0) | 1218 (65.9) | 1187 (58.5) | 2031 (61.7) | 1021 (67.5) | 1010 (56.8) | 2719 (69.2) | 1098 (75.6) | 1621 (65.5) | < 0.001 |
| Heart failure | 146 (4.2) | 18 (2.8) | 128 (4.4) | 227 (5.3) | 71 (3.9) | 156 (6.2) | 186 (4.8) | 42 (2.3) | 144 (7.1) | 179 (5.4) | 36 (2.4) | 143 (8.0) | 247 (6.3) | 44 (3.0) | 203 (8.2) | < 0.001 |
| Acute kidney injury | 587 (16.7) | 71 (11.2) | 516 (17.9) | 636 (14.8) | 171 (9.5) | 465 (18.5) | 504 (13.0) | 115 (6.2) | 389 (19.2) | 495 (15.0) | 103 (6.8) | 392 (22.0) | 556 (14.2) | 80 (5.5) | 476 (19.2) | < 0.001 |
| Staging of CKD | < 0.001 | |||||||||||||||
| G1–2 | 1537 (43.7) | 350 (55.0) | 1187 (41.2) | 1895 (44.0) | 958 (53.3) | 937 (37.4) | 1756 (45.3) | 1050 (56.8) | 706 (34.8) | 1400 (42.5) | 824 (54.5) | 576 (32.4) | 1541 (39.2) | 762 (52.5) | 779 (31.5) | |
| G3 | 743 (21.1) | 157 (24.7) | 586 (20.3) | 976 (22.7) | 502 (27.9) | 474 (18.9) | 948 (24.5) | 540 (29.2) | 408 (20.1) | 835 (25.4) | 498 (32.9) | 337 (18.9) | 1010 (25.7) | 509 (35.1) | 501 (20.2) | |
| G4 | 444 (12.6) | 59 (9.3) | 385 (13.4) | 593 (13.8) | 179 (10.0) | 414 (16.5) | 529 (13.6) | 173 (9.4) | 356 (17.6) | 472 (14.2) | 140 (9.3) | 332 (18.7) | 603 (15.4) | 132 (9.1) | 471 (19.0) | |
| G5 | 794 (22.6) | 70 (11.0) | 724 (25.1) | 842 (19.6) | 159 (8.8) | 683 (27.2) | 643 (16.6) | 85 (4.6) | 558 (27.5) | 584 (17.7) | 50 (3.3) | 534 (30.0) | 774 (19.7) | 49 (3.4) | 725 (29.3) | |
| Serum potassium (mmol/L) | < 0.001 | |||||||||||||||
| < 5.5 | 3405 (96.8) | 616 (96.9) | 2789 (96.8) | 4206 (97.7) | 1753 (97.5) | 2453 (97.8) | 3808 (98.2) | 1821 (98.5) | 1987 (98.0) | 3217 (97.8) | 14719 (97.3) | 1746 (98.1) | 3830 (97.5) | 1436 (98.9) | 2394 (96.7) | |
| 5.5-6.0 | 77 (2.2) | 13 (2.0) | 64 (2.2) | 71 (1.6) | 33 (1.8) | 38 (1.5) | 50 (1.3) | 20 (1.1) | 30 (1.5) | 50 (1.5) | 28 (1.9) | 22 (1.2) | 74 (1.9) | 12 (0.8) | 62 (2.5) | |
| > 6.0 | 36 (1.0) | 7 (1.1) | 29 (1.0) | 29 (0.7) | 12 (0.7) | 17 (0.7) | 18 (0.5) | 7 (0.4) | 11 (0.5) | 24 (0.7) | 13 (0.9) | 11 (0.6) | 24 (0.6) | 4 (0.3) | 20 (0.8) | |
| Albuminuria | 0.096 | |||||||||||||||
| A2 | 451 (12.8) | 95 (14.9) | 356 (12.4) | 556 (12.9) | 254 (14.1) | 302 (12.0) | 492 (12.7) | 221 (12.0) | 271 (13.4) | 416 (12.6) | 201 (13.3) | 215 (12.1) | 478 (12.2) | 183 (12.6) | 295 (11.9) | |
| A3 | 3067 (87.2) | 541 (85.1) | 2526 (87.6) | 3750 (87.1) | 1544 (85.9) | 2206 (88.0) | 3384 (87.3) | 1627 (88.0) | 1757 (86.6) | 2875 (87.4) | 1311 (86.7) | 1564 (87.9) | 3475 (87.8) | 1269 (87.4) | 2181 (88.1) | |
Table 3 Multivariate logistic regression on characteristics associated with renin-angiotensin system inhibitors prescriptions in all chronic kidney disease patients
| Characteristic | P value | Odds ratio (95%CI) |
| Gender, male versus female | 0.012 | 1.077 (1.016, 1.141) |
| Year of admission | < 0.001 | |
| 2012-2013 | 3.532 (3.214, 3.881) | |
| 2014-2015 | 4.529 (4.118, 4.982) | |
| 2016-2017 | 4.070 (3.694, 4.485) | |
| 2018-2019 | 2.818 (2.555, 3.107) | |
| Age, yr | < 0.001 | |
| 60 ≤ age < 70 | < 0.001 | 0.764 (0.707, 0.826) |
| 70 ≤ age < 80 | < 0.001 | 0.703 (0.633, 0.781) |
| 80 ≤ age < 90 | < 0.001 | 0.558 (0.462, 0.675) |
| ≥ 90 | 0.185 | 0.544 (0.221, 1.338) |
| Departments | < 0.001 | |
| Cardiology | < 0.001 | 0.599 (0.542, 0.663) |
| Endocrinology | < 0.001 | 0.486 (0.430, 0.548) |
| Neurology | < 0.001 | 0.271 (0.202, 0.364) |
| Pulmonary | < 0.001 | 0.112 (0.078, 0.161) |
| Surgery | < 0.001 | 0.024 (0.018, 0.031) |
| Others | < 0.001 | 0.150 (0.133, 0.169) |
| Stage of CKD | < 0.001 | |
| CKD2 | 0.259 | 1.050 (0.965, 1.142) |
| CKD3 | < 0.001 | 0.807 (0.743, 0.875) |
| CKD4 | < 0.001 | 0.260 (0.234, 0.289) |
| CKD5 | < 0.001 | 0.149 (0.133, 0.166) |
| Acute kidney injury | < 0.001 | 0.857 (0.788, 0.932) |
| Hypertension | < 0.001 | 2.798 (2.624, 2.984) |
| Diabetes | < 0.001 | 1.245 (1.164, 1.332) |
| Glomerulonephritis | < 0.001 | 1.179 (1.091, 1.275) |
| Proteinuria | < 0.001 | 1.553 (1.434, 1.680) |
Table 4 Multivariate logistic regression on characteristics associated with renin-angiotensin system inhibitors prescriptions in guideline-recommended chronic kidney disease patients
| Characteristics | P value | Odds ratio (95%CI) |
| Gender, male versus female | 0.020 | 1.089 (1.014, 1.170) |
| Year of admission | < 0.001 | |
| 2012-2013 | 3.795 (3.384, 4.255) | |
| 2014-2015 | 4.799 (4.269, 5.394) | |
| 2016-2017 | 4.648 (4.117, 5.247) | |
| 2018-2019 | 2.913 (2.589, 3.276) | |
| Age, yr | < 0.001 | |
| 60 ≤ age < 70 | 0.008 | 0.873 (0.790, 0.964) |
| 70 ≤ age < 80 | 0.001 | 0.767 (0.660, 0.891) |
| 80 ≤ age < 90 | 0.008 | 0.639 (0.459, 0.889) |
| ≥ 90 | 0.290 | 0.320 (0.039, 2.647) |
| Diastolic blood pressure | < 0.001 | |
| ≥ 90 mmHg | < 0.001 | 1.195 (1.110, 1.287) |
| < 60 mmHg | 0.004 | 0.666 (0.506, 0.877) |
| Department | < 0.001 | |
| Cardiology | < 0.001 | 0.731 (0.624, 0.857) |
| Endocrinology | < 0.001 | 0.523 (0.459, 0.595) |
| Neurology | < 0.001 | 0.361 (0.221, 0.591) |
| Pulmonary | < 0.001 | 0.113 (0.061, 0.208) |
| Surgery | < 0.001 | 0.107 (0.068, 0.169) |
| Others | < 0.001 | 0.299 (0.260, 0.344) |
| Stage of CKD | < 0.001 | |
| CKD2 | 0.548 | 1.031 (0.933, 1.139) |
| CKD3 | < 0.001 | 0.808 (0.732, 0.890) |
| CKD4 | < 0.001 | 0.245 (0.217, 0.277) |
| CKD5 | < 0.001 | 0.880 (0.077, 0.101) |
| Acute kidney injury | 0.003 | 0.835 (0.742, 0.939) |
| Hypertension | < 0.001 | 2.513 (2.318, 2.724) |
| Diabetes | < 0.001 | 1.218 (1.118, 1.327) |
| IgA nephropathy | < 0.001 | 1.498 (1.368, 1.640) |
| Heart failure | 0.045 | 0.825 (0.685, 0.995) |
| Proteinuria | < 0.001 | 1.400 (1.227, 1.597) |
- Citation: Zhang C, Duan ZY, Nie SS, Zhang Z, Guo XR, Zhang CY, Dong J, Cai GY. Renin-angiotensin system inhibitors prescriptions in Chinese hospitalized chronic kidney disease patients. World J Clin Cases 2024; 12(17): 3061-3075
- URL: https://www.wjgnet.com/2307-8960/full/v12/i17/3061.htm
- DOI: https://dx.doi.org/10.12998/wjcc.v12.i17.3061