Angiotensin converting enzyme inhibitors and angiotensin receptor blockers (ACEi/ARB) improve predialysis outcomes; however, ACEi/ARB are underutilized in patients transitioning to dialysis. We examined the association of different patterns of predialysis ACEi/ARB use with postdialysis survival, and whether potentially modifiable adverse events are associated with lower predialysis ACEi/ARB utilization.