Kidney Week

Abstract: TH-PO553

Metformin Prescription in a Contemporary Cohort of Patients with Stage 3a CKD

Session Information

• CKD: Health Services, Disparities, Prevention
  November 02, 2017 | Location: Hall H, Morial Convention Center
  Abstract Time: 10:00 AM - 10:00 AM

Category: Chronic Kidney Disease (Non-Dialysis)

• 307 CKD: Health Services, Disparities, Prevention

Authors

• Ferrandino, Rocco, Icahn School of Medicine at Mount Sinai, New York, New York, United States

Rocco Ferrandino,

• Van Vleck, Tielman T, Icahn School of Medicine at Mount Sinai, New York, New York, United States

Tielman T Van Vleck,

• Leventhal, Jeremy S., Icahn School of Medicine at Mount Sinai, New York, New York, United States

Jeremy S. Leventhal,

• Ferket, Bart, Icahn School of Medicine at Mount Sinai, New York, New York, United States

Bart Ferket,

• Uribarri, Jaime, Icahn School of Medicine at Mount Sinai, New York, New York, United States

Jaime Uribarri,

• Coca, Steven G., Icahn School of Medicine at Mount Sinai, New York, New York, United States

Steven G. Coca,

• Nadkarni, Girish N., Icahn School of Medicine at Mount Sinai, New York, New York, United States

Girish N. Nadkarni,

Background

Eligibility criteria for metformin have shifted from serum creatinine (SCr) to estimated glomerular filtration rate (eGFR) based guidelines. In 2009, the American Diabetes Association endorsed metformin use in type 2 diabetes (T2D) patients with stage 3a chronic kidney disease (CKD3a). We evaluated contemporary prescribing patterns in patients with CKD3a with as well as patient/process of care factors associated with non-prescription of metformin in a large multiethnic cohort.

Methods

We identified T2D patients with CKD3a from Mount Sinai CKD registry and calculated proportion of eligible patients actually receiving metformin. We then used nearest neighbor propensity matching to compare adjusted odds ratios (aOR) for non-prescription in user: non-user pairs. We also used natural language processing (NLP) tools to query clinical documentation for process of care factors.

Results

We identified 5213 metformin-eligible patients in 2015-16 based on eGFR criteria. Of these, only 1992 (38.2%) received metformin. We identified 1820 user: non-user matched pairs. Patient-specific factors associated with non-prescription included male sex (aOR 1.67, 95% CI 1.12-2.47) and black race (aOR 1.79, 95% CI 1.09-2.91). Interestingly, 21.7% of male and 20.3% of black patients eligible by eGFR guidelines were ineligible by SCr guidelines. Patients in whom other preventative T2D guidelines were adhered to (identified by NLP) had lower non-prescription odds. (Figure)

Conclusion

Despite a shift to eGFR-based guidelines and eGFR threshold lowering, a substantial proportion of eligible patients do not receive metformin. Factors responsible may be continued adherence to outdated guidelines, and patient/process of care specific factors, which should be explored in greater detail.

Figure. Factors associated with metformin non-prescription identified by analysis of structured and unstructured data. Asterisks(*) denote factors identified by NLP.

Funding

• Other NIH Support