In the Medicare population with heart failure, angiotensin-converting enzyme inhibitors (ACEI) or angiotensin receptor blockers (ARB) are only prescribed to 44.2% of ESRD patients receiving hemodialysis. Patients without CKD, on the other hand, had a prevalence utilisation rate of 57.3 percent, whereas those with CKD had a rate of 52.0 percent. The utilization rate for advanced CKD stages 4 through 5 was just 42.4%. Beta-blockers and other medications are prescribed to a vulnerable population whose rates of heart failure and acute myocardial infarction are rising instead of using anti-RAAS therapy. Patients with chronic kidney disease (CKD) and those without heart failure have nearly identical medication usage data. There probably aren't many reasons for this, and none of them are good. To begin, there may be a reluctance to use these medications until the very end for fear of accelerating the rate at which kidney decline progresses.