Kidney Week

Abstract: SA-PO1209

Access to Clinical Pharmacy Services in US Veterans with CKD

Session Information

• CKD: Biomarkers and Emerging Tools for Diagnosis and Monitoring
  November 08, 2025 | Location: Exhibit Hall, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: CKD (Non-Dialysis)

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

Authors

• Yamada, Masaaki, Iowa City VA Medical Center, Iowa City, Iowa, United States

Masaaki Yamada, MD

• Brown, Sophia C, Iowa City VA Medical Center, Iowa City, Iowa, United States

Sophia C Brown, PharmD

• Shi, Qianyi, Iowa City VA Medical Center, Iowa City, Iowa, United States

Qianyi Shi, PhD

• Jalal, Diana I., Iowa City VA Medical Center, Iowa City, Iowa, United States

Diana I. Jalal, MD, FASN

• Lund, Brian C., Iowa City VA Medical Center, Iowa City, Iowa, United States

Brian C. Lund, PharmD

Background

Chronic kidney disease (CKD) affects 1 in 7 U.S. adults and significantly increases the risk of cardiovascular disease. Rural patients face up to a 23% higher mortality risk compared to their urban counterparts, highlighting a critical urban-rural health disparity. Clinical pharmacists (CPs) can promote evidence-based CKD care through comprehensive medication management and help address this disparity. However, CP services remain underutilized among rural Veterans. Moreover, little is known about how access to CP services differs between urban and rural Veterans. This study aimed to: 1. Estimate differences in access to CP services between urban and rural Veterans with CKD; and 2. Characterize how these services are delivered to Veterans with CKD

Methods

This retrospective cohort study used Veterans Affairs administrative data to identify Veterans with prevalent CKD, defined as having ≥2 eGFR readings <60 mL/min/1.73 m² at least 90 days apart between 2017 and 2019. Multivariable logistic regression was used to assess the likelihood of a CP encounter (CPE), stratified by residence (urban vs. rural) and VA care site (medical center, urban community-based outpatient clinic [CBOC], or rural CBOC)

Results

In 2017, 13.7% of rural Veterans with CKD had a CPE, compared to 15.5% of urban Veterans (p <0.01). By 2019, CP utilization had increased for both rural (17.2%) and urban (18.1%) Veterans. Although unadjusted CPE rates remained statistically lower among rural residents in 2019, adjusted analyses slightly favored rural residents (adjusted odds ratio [aOR]=1.05; 95% CI: 1.03-1.07). In contrast, more substantial differences were observed across care sites. Veterans receiving primary care at medical centers were more likely to have a CPE (21.3%) compared to those at urban CBOCs (16.3%; aOR=0.69; 95% CI: 0.68-0.70) or rural CBOCs (14.3%; aOR=0.61; 95% CI: 0.59-0.62). Among Veterans with CKD who had a CPE, rural Veterans were more likely to receive CP care via telehealth (63.5%) compared to urban Veterans (56.3%). In both groups, >95% of CPEs were delivered by primary care pharmacists

Conclusion

Among Veterans with CKD, CP service utilization was more strongly influenced by the site of care than by residential location. These findings suggest that Veterans receiving primary care at CBOCs—particularly in rural areas—may face barriers to accessing CP services

Funding

• Veterans Affairs Support

Digital Object Identifier (DOI)

• doi: 10.1681/ASN.2025a15z4v1t