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Kidney Week

Abstract: PO0579

Uptake of Evidence-Based Recommendations to Improve Care for CKD Patients in the Kidney Coordinated Health Management Partnership (Kidney CHAMP) Study

Session Information

Category: CKD (Non-Dialysis)

  • 2102 CKD (Non-Dialysis): Clinical, Outcomes, and Trials

Authors

  • Weltman, Melanie R., University of Pittsburgh School of Pharmacy, Pittsburgh, Pennsylvania, United States
  • Chen, Huiwen, University of Pittsburgh Renal-Electrolyte Division, Pittsburgh, Pennsylvania, United States
  • Yabes, Jonathan, University of Pittsburgh Department of Medicine, Pittsburgh, Pennsylvania, United States
  • Cai, Manqi, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania, United States
  • Abdel-Kader, Khaled, Vanderbilt University Division of Nephrology and Hypertension, Nashville, Tennessee, United States
  • Jhamb, Manisha, University of Pittsburgh Renal-Electrolyte Division, Pittsburgh, Pennsylvania, United States
  • Nolin, Thomas D., University of Pittsburgh School of Pharmacy, Pittsburgh, Pennsylvania, United States
Background

Medication therapy in patients with chronic kidney disease (CKD) is focused on slowing CKD progression, managing causes of CKD, and preventing cardiovascular morbidity and mortality. The aim of this project was to assess the uptake of evidence-based medication recommendations (recs) provided to primary care providers (PCP) of patients with high-risk CKD by an interdisciplinary nephrology team.

Methods

This project is part of Kidney CHAMP, an ongoing NIH funded, pragmatic randomized controlled trial testing an electronic health record (EHR)-based population health management (PHM) approach to improve CKD care. Eligible patients are 18-85 years with CKD who have a high risk of progression to ESKD and are not being followed by a nephrologist. Patients in the intervention arm receive a nephrologist-led electronic consult and pharmacist-led telephonic medication therapy management (MTM). Recs are provided in the EHR for the PCP to review and order at the upcoming office visit. We focused on medication recs related to the progression of CKD and prevention of cardiovascular disease, which included use of RAAS inhibitors, SGLT2 inhibitors, GLP-1 receptor agonists, and HMG-CoA reductase inhibitors (statins).

Results

From July 1, 2019 to January 31, 2020, 125 patients received an e-consult and 121 patients received MTM. A total of 83 recs were provided to PCPs. Uptake of recs for initiation or dose escalation of RAAS inhibitors was the highest, with 19 of 46 recs (41%) being implemented. Two of eight recs regarding GLP-1 receptor agonists were implemented (25%) and two of 24 recs for SGLT-2 inhibitor initiation were implemented (8%). Five recs for statin initiation were made and none were implemented; however, baseline statin use was high at >75%.

Conclusion

Many patients with high risk CKD receive suboptimal care, which can be effectively identified by interdisciplinary nephrology teams using an EHR-based PHM platform. Uptake of RAAS inhibitor recs was highest. However, initiation of medications with recent FDA approved indications for CKD management remained poor. Future research is needed to identify barriers and strategies to increase uptake of evidence-based CKD recs and thereby improve patient care.

Funding

  • NIDDK Support