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Kidney Week

Abstract: SA-PO490

Limitations to the Use of Guideline-Directed Medical Therapy (GDMT) in Patients with CKD and Type 2 Diabetes Mellitus (DM) in the Primary Care Setting at an Inner-City Hospital in Bronx, New York

Session Information

Category: Diabetic Kidney Disease

  • 702 Diabetic Kidney Disease: Clinical

Authors

  • Santana De Roberts, Rosalba Y., NYC Health and Hospitals North Central Bronx, New York, New York, United States
  • Jim, Belinda, New York City Health and Hospitals Jacobi, Bronx, New York, United States
  • Bejugam, Vishal Reddy, NYC Health and Hospitals North Central Bronx, New York, New York, United States
  • Kolli, Shiny Teja, NYC Health and Hospitals North Central Bronx, New York, New York, United States
  • Oo, Zin Thawdar, NYC Health and Hospitals North Central Bronx, New York, New York, United States
  • Taveras Garcia, Bruna, NYC Health and Hospitals North Central Bronx, New York, New York, United States
  • Piplani, Shobhit, NYC Health and Hospitals North Central Bronx, New York, New York, United States
  • Okogbaa, Chinweizu Deborah, NYC Health and Hospitals North Central Bronx, New York, New York, United States
  • Aljareh, Amr Walid, NYC Health and Hospitals North Central Bronx, New York, New York, United States
  • Asuzu, Chisom, NYC Health and Hospitals North Central Bronx, New York, New York, United States
  • Nihalani, Sonam, NYC Health and Hospitals North Central Bronx, New York, New York, United States
Background

In 2022, KDIGO modified its GDMT for CKD and Type 2 DM patients to include SGLT-2 inhibitors (SGLT2i’s) along with angiotensin converting enzyme inhibitors or angiotensin receptor blockers (ACEI/ARB) as first-line therapy. However, many patients are discontinued due to adverse effects of an initial decline in estimated glomerular filtration rate (eGFR), frequent yeast infections, urinary tract infections, and euglycemic ketoacidosis. We aimed to study which limitations affect practice patterns in our hospital.

Methods

We conducted a retrospective analysis of patients with CKD and Type 2 DM from the primary care clinics from North Central Bronx Hospital, a community hospital in Bronx, NY, from July of 2019 to July of 2022. Statistical analysis was performed using the SPSS program where dichotomic variables and their relationships were analyzed using Chi square and binary logistic regression.

Results

Out of 419 patients recruited, 66.8% were found to be prescribed an ACEI/ARB, while 20.5% were prescribed SGLT-2i’s. A history of hyperkalemia showed a decreased odds ratio (OR) (0.460, 0.28-0.73 CI 95%, P=0.04), whereas a microalbuminuria check showed an increased OR (1.923, 1.2-1.9 95% CI, P=0.04) of an ACEI/ARB prescription respectively. CKD stage was also found to affect ACEI/ARB prescription with more patients been prescribed in stages 2, 3a, 3b (78.2%, 68.6%, 67.9%) and less in patients with CKD stages 4, 5, (55.6%,47.6%), respectively, P= 0.015. In the regression model, the only independent variable found to affect SGLT-2i prescriptions was microalbuminuria, where patients who had a microalbuminuria check within last year were more likely to have been prescribed an SGLT-2i OR=2.5, 1.11-3.12 CI 95%, p= 0.019.

Conclusion

A history of hyperkalemia and advanced CKD stage are limiting factors to prescribing ACEI/ARB, while not checking microalbuminuria are limiting factors to prescribing ACEI/ARB and SGLT-2 inhibitors.