{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T08:25:13Z","timestamp":1789979113321,"version":"4.0.1"},"reference-count":26,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"8","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["CJASN"],"published-print":{"date-parts":[[2016,8]]},"abstract":"\n Background and objectives<\/jats:title>\n The transition from CKD to ESRD can be particularly unstable, with high rates of death and hospitalizations. Few studies have examined medication use during this critical period. We examined patterns of antihypertensive medication use from the four quarters before and eight quarters after incident ESRD treated with maintenance dialysis.<\/jats:p>\n <\/jats:sec>\n \n Design, setting, participants, & measurements<\/jats:title>\n We used the US Renal Data System to identify patients aged \u226567 years initiating dialysis for ESRD between January 2008 and December 2010 with Medicare Part D and a low-income subsidy. We ascertained the incidence of AKI and hyperkalemia during each quarter on the basis of having at least 1 payment claim for the condition. We used Poisson regression with robust SEMs to formally test for changes in the trend and level of antihypertensive medication use in a series of intervention analyses.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n The number of antihypertensive drugs used increased as patients neared ESRD, peaking at an average of 3.4 in the quarter immediately preceding dialysis initiation, then declining to 2.2 medications by 2 years later. Angiotensin-converting enzyme inhibitor\/angiotensin II receptor blocker use was stable at approximately 40%, even among patients with coronary disease and systolic heart failure, and did not correlate with AKI or hyperkalemia. Dialysis initiation was associated with a 40% (95% confidence interval, 38% to 43%) lower adjusted level of diuretic use, which continued to decline after ESRD. Three- and four-drug combinations that included a diuretic were most common before ESRD, whereas after ESRD, one- and two-drug\n \u03b2<\/jats:italic>\n -blocker or calcium-channel blocker\u2013based combinations were most common.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n The use of antihypertensive medications, particularly angiotensin-converting enzyme inhibitor\/angiotensin II receptor blockers and diuretics, may be suboptimal during the transition from CKD to ESRD, especially in patients with coronary disease or systolic heart failure. Future studies are needed to identify strategies to increase the appropriate use of antihypertensive medications during this critical transition period.<\/jats:p>\n <\/jats:sec>","DOI":"10.2215\/cjn.10611015","type":"journal-article","created":{"date-parts":[[2016,6,29]],"date-time":"2016-06-29T12:24:30Z","timestamp":1467203070000},"page":"1401-1412","source":"Crossref","is-referenced-by-count":30,"title":["Antihypertensive Medication Use in Older Patients Transitioning from Chronic Kidney Disease to End-Stage Renal Disease on Dialysis"],"prefix":"10.2215","volume":"11","author":[{"given":"Tara I.","family":"Chang","sequence":"first","affiliation":[{"name":"Division of Nephrology, Stanford University School of Medicine, Stanford, California; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuanchao","family":"Zheng","sequence":"additional","affiliation":[{"name":"Division of Nephrology, Stanford University School of Medicine, Stanford, California; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria E.","family":"Montez-Rath","sequence":"additional","affiliation":[{"name":"Division of Nephrology, Stanford University School of Medicine, Stanford, California; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wolfgang C.","family":"Winkelmayer","sequence":"additional","affiliation":[{"name":"Selzman Institute for Kidney Health, Section of Nephrology, Baylor College of Medicine, Houston, Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2016,6,27]]},"reference":[{"key":"B1-20230816","doi-asserted-by":"crossref","first-page":"2642","DOI":"10.2215\/CJN.03680411","article-title":"Early outcomes among those initiating chronic dialysis in the United States.","volume":"6","author":"Chan","year":"2011","journal-title":"Clin J Am Soc Nephrol"},{"key":"B2-20230816","doi-asserted-by":"crossref","first-page":"392","DOI":"10.1038\/ki.2014.15","article-title":"Early mortality in patients starting dialysis appears to go unregistered.","volume":"86","author":"Foley","year":"2014","journal-title":"Kidney Int"},{"issue":"Suppl 1","key":"B3-20230816","first-page":"S1","article-title":"US Renal Data System 2014 Annual Data Report: Epidemiology of Kidney Disease in the United States.","volume":"66","author":"Saran","year":"2015","journal-title":"Am J Kidney Dis"},{"key":"B4-20230816","doi-asserted-by":"crossref","first-page":"507","DOI":"10.1001\/jama.2013.284427","article-title":"2014 evidence-based guideline for the management of high blood pressure in adults: report from the panel members appointed to the Eighth Joint National Committee (JNC 8).","volume":"311","author":"James","year":"2014","journal-title":"JAMA"},{"key":"B5-20230816","doi-asserted-by":"crossref","first-page":"377","DOI":"10.1038\/ki.2012.425","article-title":"Summary of KDIGO guideline. What do we really know about management of blood pressure in patients with chronic kidney disease?","volume":"83","author":"Wheeler","year":"2013","journal-title":"Kidney Int"},{"key":"B7-20230816","doi-asserted-by":"crossref","first-page":"987","DOI":"10.1161\/01.CIR.103.7.987","article-title":"Impact of aortic stiffness attenuation on survival of patients in end-stage renal failure.","volume":"103","author":"Guerin","year":"2001","journal-title":"Circulation"},{"key":"B8-20230816","doi-asserted-by":"crossref","first-page":"2507","DOI":"10.1093\/ndt\/gfl293","article-title":"Candesartan, an angiotensin II type-1 receptor blocker, reduces cardiovascular events in patients on chronic haemodialysis--a randomized study.","volume":"21","author":"Takahashi","year":"2006","journal-title":"Nephrol Dial Transplant"},{"key":"B9-20230816","first-page":"e391","article-title":"2009 focused update incorporated into the ACC\/AHA 2005 guidelines for the diagnosis and management of heart failure in 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Nephrol"},{"key":"B12-20230816","doi-asserted-by":"crossref","first-page":"357","DOI":"10.1161\/CIRCULATIONAHA.109.865352","article-title":"Use of evidence-based therapies in short-term outcomes of ST-segment elevation myocardial infarction and non-ST-segment elevation myocardial infarction in patients with chronic kidney disease: A report from the National Cardiovascular Data Acute Coronary Treatment and Intervention Outcomes Network registry.","volume":"121","author":"Fox","year":"2010","journal-title":"Circulation"},{"key":"B13-20230816","doi-asserted-by":"crossref","first-page":"670","DOI":"10.1053\/j.ajkd.2011.10.047","article-title":"Utilization and costs of cardiovascular disease medications in dialysis patients in Medicare Part D.","volume":"59","author":"Frankenfield","year":"2012","journal-title":"Am J Kidney Dis"},{"key":"B14-20230816","doi-asserted-by":"crossref","first-page":"1021","DOI":"10.1007\/s11255-009-9606-1","article-title":"Patterns of cardioprotective medication prescription in incident hemodialysis patients.","volume":"41","author":"Sood","year":"2009","journal-title":"Int Urol Nephrol"},{"key":"B15-20230816","doi-asserted-by":"crossref","first-page":"2809","DOI":"10.1093\/ndt\/gfp212","article-title":"Prescription of antihypertensive agents to haemodialysis patients: Time trends and associations with patient characteristics, country and survival in the DOPPS.","volume":"24","author":"Lopes","year":"2009","journal-title":"Nephrol Dial Transplant"},{"key":"B16-20230816","doi-asserted-by":"crossref","first-page":"1473","DOI":"10.1093\/ajhp\/61.14.1473","article-title":"Patterns of antihypertensive medication use in hemodialysis patients.","volume":"61","author":"Rahman","year":"2004","journal-title":"Am J Health Syst Pharm"},{"key":"B18-20230816","doi-asserted-by":"crossref","first-page":"225","DOI":"10.1053\/j.ajkd.2005.04.029","article-title":"Identification of individuals with CKD from Medicare claims data: A validation 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A clinical update from Kidney Disease: Improving Global Outcomes (KDIGO).","volume":"80","author":"Herzog","year":"2011","journal-title":"Kidney Int"}],"container-title":["Clinical Journal of the American Society of Nephrology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/01277230-201608000-00014","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,10]],"date-time":"2026-08-10T13:46:38Z","timestamp":1786369598000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/01277230-201608000-00014"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2016,6,27]]},"references-count":26,"journal-issue":{"issue":"8","published-print":{"date-parts":[[2016]]}},"URL":"https:\/\/doi.org\/10.2215\/cjn.10611015","relation":{},"ISSN":["1555-9041","1555-905X"],"issn-type":[{"value":"1555-9041","type":"print"},{"value":"1555-905X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2016,6,27]]}}}