ASSESSING THE CURRENT LANDSCAPE: UTILIZATION TRENDS OF RAAS INHIBITORS IN HYPERTENSION MANAGEMENT FOR NON-DIALYSIS DEPENDENT CKD PATIENTS AMONG PHYSICIANS

ASSESSING THE CURRENT LANDSCAPE: UTILIZATION TRENDS OF RAAS INHIBITORS IN HYPERTENSION MANAGEMENT FOR NON-DIALYSIS DEPENDENT CKD PATIENTS AMONG PHYSICIANS

Chronic Kidney Disease (CKD) and hypertension are common comorbid conditions and present a significant healthcare challenge. The use of Renin-Angiotensin-Aldosterone System inhibitors (RAASi) is a cornerstone in managing hypertension in non-dialysis-dependent CKD patients. This study sought to assess the utilization trends and considerations of RAASi among physicians in India, aiming to provide valuable insights into clinical practices in this context.

A comprehensive questionnaire-based survey was conducted, garnering responses from 252 physicians across various affiliations, including government hospitals (29%), private multispeciality hospitals (11.5%), private clinics (25%), and academic medical centers or university hospitals (34%). The survey encompassed a wide array of questions designed to evaluate the clinical practices, attitudes, and challenges faced by these physicians in the management of hypertension in non-dialysis-dependent CKD patients, with a specific focus on the utilization of RAASi.

Most participating physicians (87.7%) reported regularly treating non-dialysis-dependent CKD patients with hypertension. The survey revealed that calcium channel blockers (46%) were the preferred first-line antihypertensive agents, followed by beta blockers (23%) and ACE inhibitors or Angiotensin II Receptor Blockers (ARBs) (17.8%). While 38% of physicians did not prescribe RAASi to CKD hypertensive patients requiring multiple antihypertensive medications, a significant proportion expressed familiarity with ARBs (65%) and ACE inhibitors (35%). Notably, the decision to initiate RAASi was influenced by several factors, including evidence of proteinuria (69.8%), estimated Glomerular Filtration Rate (eGFR) (76.2%), and the presence of comorbidities (56%). Physicians primarily assessed the effectiveness of RAASi through blood pressure control (66.7%) and a reduction in proteinuria (61.1%). The most prevalent challenges and concerns reported by physicians in the survey pertained to intolerance or adverse effects, particularly hyperkalemia (82.5%), and concerns over the rise in serum creatinine (62.7%). Physicians' confidence levels in managing patients who experienced a rise in serum creatinine while on RAASi varied, with 19% reporting being very confident while 37% expressing a lack of confidence in managing this specific scenario. When patients experienced a rise in serum creatinine, physicians' responses included temporarily discontinuing the RAASi (65%), adjusting the dosage (44.4%), and referring to nephrologist (33.3%). The survey findings revealed lack of consensus on percentage increase in serum creatinine that would serve as a threshold for discontinuing RAASi with 40% physicians setting threshold of 20% or higher while 33% chose 30%. Most physicians believed that there were reservations among their colleagues regarding the use of RAASi in non-dialysis-dependent CKD patients with hypertension (64.7%). Regarding suggested changes to current practice, respondents recommended Development of decision support tools or algorithms (89%), increased collaboration between nephrologists and primary care physicians (80.5%) and regular monitoring and reporting of patient outcomes on RAASi (71%).

This survey-based study provides a comprehensive assessment of the current landscape of RAASi utilization among physicians. We observed that physicians still approach the use of RAASi cautiously, particularly concerning the potential rise in serum creatinine, which influences their treatment decisions. Furthermore, there is pressing need to promote its use in this patient subset, as physicians serve as primary point of contact for these individuals. Increased education, collaborative efforts, and standardized practices are vital for optimizing care for non-dialysis-dependent CKD patients with hypertension and enhancing healthcare outcomes in India.