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Kidney Week

Abstract: TH-PO970

ICD Pieces: A Pragmatic Clinical Trial in Patients With CKD, Diabetes, and Hypertension

Session Information

Category: CKD (Non-Dialysis)

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

Authors

  • Vazquez, Miguel A., The University of Texas Southwestern Medical Center, Dallas, Texas, United States
  • Oliver, George R., Parkland Health and Hospital System, Dallas, Texas, United States
  • Sundaram, Venkatraghavan, Parkland Health and Hospital System, Dallas, Texas, United States
  • Chan, Kevin L., National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, Maryland, United States
  • Ahn, Chul, The University of Texas Southwestern Medical Center, Dallas, Texas, United States
  • Zhang, Song, The University of Texas Southwestern Medical Center, Dallas, Texas, United States
  • Nguyen, Tuan-Minh, Parkland Health and Hospital System, Dallas, Texas, United States
  • Bickel, Perry, The University of Texas Southwestern Medical Center, Dallas, Texas, United States
  • Miller, R. Tyler, The University of Texas Southwestern Medical Center, Dallas, Texas, United States
  • Wells, Barbara, National Heart Lung and Blood Institute, Bethesda, Maryland, United States
  • Jaiyeola, Adeola O., Parkland Health and Hospital System, Dallas, Texas, United States
  • Hedayati, Susan, The University of Texas Southwestern Medical Center, Dallas, Texas, United States
  • Moran, Brett, Parkland Health and Hospital System, Dallas, Texas, United States
  • Santini, Noel O., Parkland Health and Hospital System, Dallas, Texas, United States
  • Barker, Blake R., The University of Texas Southwestern Medical Center, Dallas, Texas, United States
  • Velasco, Ferdinand T., Texas Health Resources, Arlington, Texas, United States
  • Myers, Lynn M., Texas Health Resources, Arlington, Texas, United States
  • Meehan, Thomas P., Quinnipiac University Frank H Netter MD School of Medicine, North Haven, Connecticut, United States
  • Rosen, Jonathan H., ProHealth Physicians Inc, Famington, Connecticut, United States
  • Toto, Robert D., The University of Texas Southwestern Medical Center, Dallas, Texas, United States
Background

Patients with the triad of CKD, type 2 diabetes (DM) and hypertension (HTN) are at high risk for kidney failure and cardiovascular morbidity and mortality. Implementation of guidelines to prevent complications from CKD, DM and HTN is suboptimal.

Methods

ICD-Pieces is a pragmatic trial in 4 health systems that randomized 11,000 patients (141 clusters) to intervention or usual care. The intervention leveraged information technology to identify patients with the triad of CKD, DM and HTN in the electronic health records for practice facilitators who assisted primary care providers to increase delivery of CKD, DM and HTN guideline care. The primary outcome was the one-year all-cause hospitalization rate and secondary outcomes included emergency department visits, readmissions and cardiovascular events.

Results

Characteristics of the study population were well balanced in the two groups with 20% of participants African American and close to 20% Hispanic. (Table 1). There was no difference in the primary outcome of one-year hospitalization rate nor in the secondary outcomes (Figure 1).

Conclusion

Practice facilitators can help primary care practices focus on guideline-based care in CKD, DM and HTN. In this study such interventions,did not translate into significant reductions in hospitalizations.

CHARACTERISTICS Intervention (n=5,508)Usual Care (n=5,492)
AgeMean +/- SD (years)68.1 +/- 10.468.9 +/- 10.3
GenderMale (%)2,958 (53.7%)2,951 (53.7%)
EthnicityHispanic or Latino (%)1,129 (20.5%)944 (17.2%)
RaceBlack or African American (%)1,159 (21%)1,088 (19.8%)
Blood PressureMean Systolic BP +/- SD (mmHg)133.1 +/- 18.7132.5 +/- 17.9
HbA1CMean +/- SD (%)7.6 +/- 2.17.5 +/- 2.1
Estimated GFRMean +/- SD (ml/min/1.73 m2) 48.1 +/- 16.849.4 +/- 15.6

One-Year Hospitalization Rate

Funding

  • NIDDK Support