Non-Diabetic Nephropathy - Use of ACE Inhibitor or ARB Therapy
The percentage of patients aged 18 years and older with proteinuria who are taking an ACE inhibitor or ARB
ACP does not support NQF 0621: “Non-Diabetic Nephropathy - Use of ACE Inhibitor or ARB Therapy.” While the clinical reasoning underlying the measure is sound, it does not reflect the most recent Kidney Disease | Improving Global Outcomes (KDIGO) guidelines on the management of CKD. Cut-points in the denominator and exclusion criteria should be updated to align with current recommended practice standards. Specifically, KDIGO recommends an angiotensin converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) for diabetic CKD patients with albumin excretion of 30-300 mg/24 hours, and for patients with albumin excretion greater than 300 mg/24 hours, regardless of diabetes status. The division of stage 3 CKD into stages 3a (GFR 45-59 ml/min/1.73 m2) and 3b (GFR 30-44 ml/min/1.73 m2) should also be noted explicitly in the exclusion criteria along with guidance as to whether both patient populations should be excluded.