Abstract: TH-PO0611
Understanding the Barriers to Guideline-Directed Medical Therapy (GDMT) Prescriptions in Patients with CKD
Session Information
- CKD: Clinical - Guidelines, Biomarkers, Progression, Procedures, Outcomes, and More
October 22, 2026 | Location: Exhibit Hall A, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: CKD (Non-Dialysis)
- 2202 CKD (Non-Dialysis): Clinical, Outcomes, and Trials
Authors
- Naing, Aung, Stanford Medicine, Stanford, California, United States
- Lakshman, Sneha, Stanford Medicine, Stanford, California, United States
- Holdsworth, Laura, Stanford Medicine, Stanford, California, United States
- Gupta, Riti, Stanford Medicine, Stanford, California, United States
- Siden, Rachel, Stanford Medicine, Stanford, California, United States
- Brady, Brian, Stanford Medicine, Stanford, California, United States
Background
Recent advances in kidney focused GDMT has transformed the treatment of CKD. Translation of these breakthroughs, to more GDMT prescribing, has been slower. We conducted a qualitative study integrating electronic medical record (EMR) chart review and structured clinician interviews to better understand barriers contributing to the delayed implementation of GDMT prescribing for patients with CKD.
Methods
We enrolled 36 individuals with CKD Stages G3A-4 who had an indication for GDMT without an active prescription, into an intensive CKD population health program. A clinical pharmacist focused on prescribing indicated GDMT and understanding the most likely barriers to non-prescription. Pharmacist clinical notes were extracted from the EMR for qualitative chart review; reasons for GDMT non-prescription were coded using in NVivo software. Additionally, semi-structured interviews were conducted with eight nephrologists to better understand common barriers to prescribing clinically indicated GDMT. These interviews were recorded, transcribed, and analyzed using a inductive-deductive thematic approach.
Results
Four major themes emerged from the chart review and thematic analysis as barriers to GDMT prescribing: (1) clinical concerns, including hyperkalemia, infections, side effects, and therapeutic inertia; (2) financial barriers, with costs influencing prescribing decisions; (3) polypharmacy and patient factors, including pill burden and patient preferences; and (4) limited awareness or variable adoption of CKD guidelines, with preference for individualized clinical judgment. Interviews highlighted complex decision-making related to patient age, fragmented care, and dispersion of prescribing responsibility across specialties.
Conclusion
This qualitative study provides novel insight into GDMT underuse in the CKD population, revealing underappreciated drivers of prescribing behavior. These insights, if further scaled, could bolster future implementation of GDMT for patients with CKD.