Abstract: TH-PO0612
TOGA-DKD: Pharmacist-Led Medication Optimization Across the Hospital-to-Home Transition
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
- Garcia, Danielle, Montefiore Einstein Medical Center, New York, New York, United States
- Golestaneh, Ladan, Yale School of Medicine, New Haven, Connecticut, United States
- Kumar, Neelja D., Montefiore Einstein Medical Center, New York, New York, United States
- Nealy, Elyza, Montefiore Einstein Medical Center, New York, New York, United States
- Stark, Allison, Montefiore Einstein Medical Center, New York, New York, United States
- Di Palo, Katherine E., Montefiore Einstein Medical Center, New York, New York, United States
Background
Guideline-directed medical therapy (GDMT) for diabetic kidney disease (DKD) is underprescribed. Hospitalization is an actionable touchpoint. Whether pharmacist-led optimization across the transition of care (TOC) can close DKD GDMT gaps, and where prescribing is most successful, is unknown.
Methods
Within the TOGA-DKD pilot at Montefiore Medical Center (9/24–12/25), 86 enrolled adults with diabetes; eGFR <60 mL/min/1.73m2,or proteinuria >30 mg/g received pharmacist-led DKD medication review at three touchpoints: bedside prior to discharge and by telephone at 2 and 14 business days post-discharge. During hospitalization, the pharmacist reviewed each regimen against DKD guidelines (RAASi, SGLT-2i, nsMRA, GLP-1 RA) and recommended changes for primary team implementation. After discharge, the pharmacist prescribed new medications via collaborative practice agreement. We assessed per-touchpoint and cumulative new DKD prescribing, and reasons why no new medication was initiated.
Results
New DKD medications were prescribed for 19 (22.1%) patients at discharge, 21 (24.4%) at the 2-day call, and 14 (16.3%) at the 14-day call. Cumulatively, 45 of 86 (52.3%) received ≥1 new DKD medication across the intervention. Per-class prescribing is shown in Table 1. Among 66 patients without a new DKD medication at discharge, inpatient team declining the pharmacist recommendation was the dominant barrier (49, 74.2%). After discharge, the leading barriers were competing care needs (24.4% at 2-day) and repeat labs (19.8% at 14-day).
Conclusion
A pharmacist-led TOC intervention achieved new DKD GDMT prescribing in over half of enrolled patients, with most new prescribing occurring post-discharge. Clinical inertia among inpatient prescribers was the dominant hospital barrier. Further evaluation, with strategies to improve inpatient team uptake of pharmacist recommendations, is warranted.
New DKD Medications Prescribed by Touchpoint (N=86)
| Medication Class | Discharge (n,%) | 2-day call (n,%) | 14-day call (n,%) |
| ACE inhibitor | 3(3.5) | 0 | 3(3.5%) |
| Angiotensin Receptor Blocker | 5(5.8%) | 1(1.2%) | 4(4.7%) |
| Non-steroidal MRA | 0 | 4(4.7%) | 4(4.7%) |
| SGLT-2 inhibitor | 13(15.1) | 16(18.6) | 5(5.8) |
| GLP1 receptor agonist | 3(3.5) | 11(12.8) | 6(7.0) |
| Any new DKD medication | 19(22.1) | 21(24.4) | 15(16.3) |
DKD, diabetic kidney disease; MRA, mineralocorticoid receptor antagonist; SGLT-2, sodium-glucose cotransporter 2; GLP-1, glucagon-like peptide-1
Funding
- Other NIH Support