# Personalizing Angiotensin-Converting Enzyme Inhibitor and Angiotensin Receptor Blocker Therapy in Chronic Kidney Disease

> **NIH NIH F32** · UNIVERSITY OF CALIFORNIA, SAN FRANCISCO · 2021 · $88,630

## Abstract

PROJECT SUMMARY/ABSTRACT
Angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) are guideline-
recommended therapies for preventing end-stage kidney disease (ESKD) and cardiovascular disease (CVD)
events in patients with CKD. However, in real-world practice, ACEIs/ARBs are frequently discontinued by
providers in the setting of acute kidney injury (AKI), rapid declines in kidney function, or advanced CKD.
Premature discontinuation of ACEIs/ARBs can lead to adverse clinical outcomes among patients with CKD.
However, discontinuation of these agents may be appropriate for certain CKD subgroups who are at higher risk
of AKI and who may derive less benefit from these agents than trial populations. Although guidelines support
the use of ACEIs/ARBs in patients with CKD, they also allow for individualization of decisions surrounding their
use. However, it is unclear how to best individualize these decisions as CKD progresses to optimize kidney
and cardiovascular outcomes.
The overall objective of this proposal is to personalize ACEI/ARB therapy for patients with CKD based on each
individual's risk factors for ESKD and CVD. To accomplish this, we will use data from the Chronic Renal
Insufficiency Cohort (CRIC) Study. We will first identify factors that drive the discontinuation of ACEIs/ARBs
(Aim 1). Next, we will build two clinical tools that model the relationship between ACEI/ARB discontinuation
and risk of ESKD (Aim 2) or CVD events (Aim 3) in individuals with CKD. Our long-term goal is to reduce the
burden of kidney disease and improve patient outcomes by individualizing medication use in CKD. We expect
that completion of these aims will result in the development of two prediction tools that can be further refined
and implemented in real-world clinical practice as part of a career development award application.
The proposed aims are integrated into a comprehensive training plan that includes a Master's Degree in
Clinical Research and practical mentored experiences. Through this training plan, Dr. Chen will have the
opportunity to 1) learn and apply knowledge in advanced biostatistical and epidemiological methods, including
marginal structural modeling; 2) gain familiarity with the CRIC Study database, 3) apply machine learning
algorithms to the development of clinical prediction tools, 4) refine skills in scientific writing and presenting
research, and 5) advance towards a career development award and independence as a clinical investigator.

## Key facts

- **NIH application ID:** 10313873
- **Project number:** 1F32DK130543-01
- **Recipient organization:** UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
- **Principal Investigator:** Debbie Catherine Chen
- **Activity code:** F32 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2021
- **Award amount:** $88,630
- **Award type:** 1
- **Project period:** 2021-07-01 → 2022-06-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10313873

## Citation

> US National Institutes of Health, RePORTER application 10313873, Personalizing Angiotensin-Converting Enzyme Inhibitor and Angiotensin Receptor Blocker Therapy in Chronic Kidney Disease (1F32DK130543-01). Retrieved via AI Analytics 2026-06-14 from https://api.ai-analytics.org/grant/nih/10313873. Licensed CC0.

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