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Abstract: SA-PO942

Acceptance of Recommendations for SGLT2 Inhibitors and GLP1 Receptor Agonists in a High-Risk CKD Population

Session Information

Category: CKD (Non-Dialysis)

  • 2202 CKD (Non-Dialysis): Clinical‚ Outcomes‚ and Trials

Authors

  • Weltman, Melanie R., UPMC, Pittsburgh, Pennsylvania, United States
  • Jhamb, Manisha, UPMC, 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
  • Nolin, Thomas D., University of Pittsburgh Renal-Electrolyte Division, Pittsburgh, Pennsylvania, United States
  • Abdel-Kader, Khaled, Vanderbilt University Medical Center, Nashville, Tennessee, United States
Background

Delaying or preventing CKD progression and reducing risk of cardiovascular events are priorities in the treatment of patients with CKD. SGLT2 inhibitors and GLP1 receptor agonists have shown kidney and cardiovascular benefit in those with CKD but prescribing of these medications remains low. We evaluated acceptance of recommendations for SGLT2 inhibitors and GLP1 receptor agonists and barriers to prescribing in a group of patients with high-risk CKD from the Kidney CHAMP trial.

Methods

The Kidney CHAMP trial is testing whether an electronic health record-based population health management approach improves CKD care. Eligible patients are 18-85 years with CKD, high risk of progression to ESKD, and are not followed by a nephrologist. Enrolled patients receive nephrologist-led electronic consults and pharmacist-led medication therapy management encounters with recommendations (including use of SGLT2 inhibitors and GLP1 receptor agonists) provided to the primary care provider (PCP) for review at the upcoming office visit, with follow-up encounters every 6 months.

Results

Between October 1, 2019 and March 31, 2022, 697 baseline encounters and 709 follow-up encounters were completed. At baseline, 4% and 6% of patients were prescribed an SGLT2 inhibitor or a GLP1 receptor agonist, respectively. 284 recommendations were made for initiation or dose adjustment of an SGLT2 inhibitor in 206 unique patients, and 206 recommendations were made for initiation or dose adjustment of a GLP1 receptor agonist in 141 unique patients. PCPs accepted 26% of recommendations for SGLT2 inhibitors and 30% of recommendations for GLP1 receptor agonists. Commonly documented reasons for not accepting the recommendations were patient refusal, deferring to endocrinology, and cost/insurance coverage limitations.

Conclusion

Baseline use and acceptance of recommendations for SGLT2 inhibitors and GLP1 receptor agonists remains poor in our patient population. Reasons for nonacceptance suggest a need for patient and provider-level education related to their benefits, as well as system-level efforts to address medication cost and siloed care.

Funding

  • NIDDK Support