Prevalence of Chronic Kidney Disease, Thrombotic Cardiovascular Events, and Use of Oral P2Y12 Inhibitors among Veterans

Abstract

Background: Contemporary prevalence of chronic kidney disease (CKD) and thrombotic cardiovascular (CV) events remains unclear in Veterans enrolled in the Veterans Affairs Health Care System (VA) care. Although oral P2Y12 inhibitors (P2Y12i) are increasingly being prescribed to this patient population, the overall prescription trend for P2Y12i remains unclear.

Methods: Using national VA corporate warehouse data, we used International Classification of Diseases-9 codes to identify Veterans with CKD, dialysis-dependent CKD, and CV events. VA pharmacy data were used to count P2Y12i prescriptions for the federal fiscal years (FY) 2011 through 2015.

Results: The period prevalence of Veterans with CKD was 378,233 (6.1%). The point prevalence of CKD increased by 49% from 132,979 (2.30%) in FY11 to 213,444 (3.42%) in FY15. The period prevalence of Veterans with dialysis-dependent CKD was 150,298 (2.4%). In all, 128,703 (56.7%) CV events occurred in Veterans with CKD. Veterans with CKD were given 50.1% of prescriptions for clopidogrel, 49.3% for prasugrel, and 60.4% for ticagrelor. In this patient population, year-to-year increases in P2Y12i prescriptions were observed with a dramatic increase in ticagrelor prescriptions.

Conclusion: CKD is common among Veterans and its true prevalence is likely being underestimated. The prevalence of dialysis-dependent CKD is higher among Veterans than the non-Veteran US population. CV events are widely co-prevalent and these patients are commonly prescribed P2Y12i. The recent increase in ticagrelor prescriptions in this patient population and large cost differences between the 3 P2Y12i underline the need for future studies to identify the preferred P2Y12i for these patients.

Keywords: Cardiovascular; Kidney; Outcomes; P2Y12 inhibitors; Prevalence.

Fig. 1.

Line graph showing the number (y-axis) of the total Veteran population enrolled in VA care (circle), Veterans with chronic kidney disease (square) and Veterans with dialysis-dependent chronic kidney disease (triangle) during fiscal years 2011 through 2015 (x-axis). Percentages on the blue and black line show proportion of Veterans with chronic kidney disease and dialysis-dependent chronic kidney disease, respectively. Please see online version for color image.

Fig. 2.

Line graph showing total number of prescriptions (y-axis) for clopidogrel (circles), prasugrel (squares) and ticagrelor (triangles) administered to Veterans with chronic kidney disease during fiscal years 2011 through 2015 (x-axis). Percentages in the line graph indicate percent annual increases in the number of prescriptions for an oral P2Y₁₂ inhibitor calculated as the difference in the prescription counts between consecutive fiscal years. Please see online version for color image.