Kidney Week

Abstract: TH-PO1151

Electronic Health Record-Based Population Health Management to Optimize Care in CKD: Kidney CHAMP Randomized Clinical Trial

Session Information

• Late-Breaking Posters
  November 02, 2023 | Location: Exhibit Hall, Pennsylvania Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: CKD (Non-Dialysis)

• 2302 CKD (Non-Dialysis): Clinical, Outcomes, and Trials

Authors

• Jhamb, Manisha, University of Pittsburgh, Pittsburgh, Pennsylvania, United States

Manisha Jhamb,

• Weltman, Melanie R., University of Pittsburgh, Pittsburgh, Pennsylvania, United States

Melanie R. Weltman,

• Devaraj, Susan M., University of Pittsburgh, Pittsburgh, Pennsylvania, United States

Susan M. Devaraj,

• Lavenburg, Linda-Marie Ustaris, University of Pittsburgh, Pittsburgh, Pennsylvania, United States

Linda-Marie Ustaris Lavenburg,

• Han, Zhuoheng, University of Pittsburgh, Pittsburgh, Pennsylvania, United States

Zhuoheng Han,

• Alghwiri, Alaa A., University of Pittsburgh, Pittsburgh, Pennsylvania, United States

Alaa A. Alghwiri,

• Fischer, Gary, University of Pittsburgh, Pittsburgh, Pennsylvania, United States

Gary Fischer,

• Rollman, Bruce L., University of Pittsburgh, Pittsburgh, Pennsylvania, United States

Bruce L. Rollman,

• Nolin, Thomas D., University of Pittsburgh, Pittsburgh, Pennsylvania, United States

Thomas D. Nolin,

• Yabes, Jonathan, University of Pittsburgh, Pittsburgh, Pennsylvania, United States

Jonathan Yabes,

Background

Large gaps in clinical care in patients with chronic kidney disease (CKD) lead to poor outcomes. We tested the effectiveness of an electronic health record (EHR)-based population health management (PHM) intervention at reducing CKD progression and improving evidence-based care in high-risk CKD.

Methods

In a pragmatic cluster randomized clinical trial, we randomized 101 primary care practices to either intervention or usual care, and enrolled patients aged 18-85 years with estimated glomerular filtration rate (eGFR) <60 ml/min/1.73m², with high risk of CKD progression and not seeing a nephrologist. Multifaceted intervention included nephrology e-consult, pharmacist-led medication management, and CKD education. Primary outcome was time to ≥40% reduction in eGFR or End Stage Kidney Disease.

Results

Among 1,596 patients with mean age 74±9 years, 58% were females, 8% were Black, and mean eGFR 36.8±7.9 ml/min/1.73m². Over a median follow-up of 17.4 months, there was no significant difference in rate of primary outcome between the two arms (adjusted hazards ratio 0.99, 95% CI 0.69, 1.42; P=0.94). Angiotensin converting enzyme inhibitor/Angiotensin receptor blocker (ACEi/ARB) exposure was more frequent in intervention arm compared to control (rate ratio 1.22, 95%CI 1.04 to 1.44, P=0.018). There was no difference in secondary outcomes of hypertension control and exposure to unsafe medications, or adverse events between the arms.

Conclusion

Among patients with moderate to high-risk CKD, a multi-faceted EHR-based PHM intervention resulted in more exposure days to ACEi/ARB but did not reduce risk of CKD progression or hypertension control versus usual care. Several COVID pandemic related factors likely contributed to null findings in our study.

Funding

• NIDDK Support