Abstract: SA-PO0469
Clinical Pharmacist Involvement and Kidney-Protective Medication Use in CKD
Session Information
- CKM: Clinical - Screening, Population Management, Care Disparities, and Patient-Centered Outcomes
October 24, 2026 | Location: Exhibit Hall A, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Cardiovascular-Kidney-Metabolic Health
- 602 Cardiovascular-Kidney-Metabolic Health: Clinical
Authors
- Yamada, Masaaki, Iowa City VA Medical Center, Iowa City, Iowa, United States
- Shi, Qianyi, University of Iowa Health Care, Iowa City, Iowa, United States
- Gao, Yubo, University of Iowa Health Care, Iowa City, Iowa, United States
- Good, Mary K., Iowa City VA Medical Center, Iowa City, Iowa, United States
- Robinson, Kathleen, Iowa City VA Medical Center, Iowa City, Iowa, United States
- Dahlke, Megan, Iowa City VA Medical Center, Iowa City, Iowa, United States
- Christ, Heather, Iowa City VA Medical Center, Iowa City, Iowa, United States
- Swee, Melissa L., Iowa City VA Medical Center, Iowa City, Iowa, United States
- Griffin, Benjamin R., Iowa City VA Medical Center, Iowa City, Iowa, United States
- Faro, Elissa Z., Hackensack Meridian Health Inc, Edison, New Jersey, United States
- Kennelty, Korey, University of Iowa Health Care, Iowa City, Iowa, United States
- Sarrazin, Mary Vaughan, University of Iowa Health Care, Iowa City, Iowa, United States
- Lund, Brian C., Iowa City VA Medical Center, Iowa City, Iowa, United States
- Jalal, Diana I., Iowa City VA Medical Center, Iowa City, Iowa, United States
Background
Renin–angiotensin system inhibitors (RASi) slow progression of chronic kidney disease (CKD); however, real-world data indicate that >50% of U.S. patients with CKD do not receive these therapies. Clinical pharmacist practitioners (CPPs) are well positioned to initiate and monitor kidney-protective therapies. We evaluated whether incident CPP care is associated with RASi initiation among Veterans with non-dialysis CKD.
Methods
We conducted a retrospective study using national Veterans Health Administration data. CKD was defined by 2 estimated glomerular filtration rate (eGFR) measurements <60 mL/min/1.73 m2 obtained ≥90 days apart during 2018-2019. We used Cox proportional hazards models to estimate the association between incident CPP care and RASi initiation over a 4-year follow-up period, with CPP encounters modeled as a time-dependent exposure. Models adjusted for demographics, body mass index, and comorbidities; and were stratified by baseline eGFR.
Results
Among 229,019 Veterans with CKD (eGFR 45-59, 70%; 30-44, 25%; 15-29, 5%), 13,164 (6%) had ≥1 CPP encounter during follow-up. CPP care recipients had slightly lower eGFR (48 vs. 49 mL/min/1.73 m2) but higher comorbidity burden (hypertension 79% vs. 73%; diabetes 55% vs. 32%). RASi initiation occurred in 36% of Veterans with CP encounters compared with 20% of those without (p <0.01). In time-to-event analyses (Table 1), CPP encounters were associated with significantly higher RASi initiation (unadjusted hazard ratio [HR] 2.9, 95% confidence interval [CI] 2.8-3.0; adjusted HR 2.5, 95% CI 2.4-2.5). Associations were consistent across eGFR strata, with modest attenuation among patients with eGFR 15-29 (adjusted HRs: 2.5 for eGFR 45-59; 2.5 for eGFR 30-44; and 2.2 for eGFR 15-29; all p <0.01).
Conclusion
In this national cohort of Veterans with non-dialysis CKD, incident CPP care was associated with approximately a two-fold higher likelihood of RASi initiation, including among patients with more advanced CKD. These findings support the expansion of CPP-led CKD management models as a scalable strategy to improve timely initiation of cornerstone kidney-protective therapies in routine clinical practice.
Funding
- Veterans Affairs Support