Abstract: TH-PO0814
Implementing Universal Pharmacogenomics Testing in Patients with ESKD at a Veterans Affairs (VA) Dialysis Center
Session Information
- Pharmacology (PharmacoKinetics, -Dynamics, -Genomics)
October 22, 2026 | Location: Exhibit Hall A, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Pharmacology (PharmacoKinetics, -Dynamics, -Genomics)
- 1900 Pharmacology (PharmacoKinetics, -Dynamics, -Genomics)
Authors
- Svete, Frank, Edward Hines Junior Veterans Affairs Hospital, Hines, Illinois, United States
- Kossifologos, Annette, Edward Hines Junior Veterans Affairs Hospital, Hines, Illinois, United States
- Schneider, Julia, Edward Hines Junior Veterans Affairs Hospital, Hines, Illinois, United States
Background
Patients with ESKD experience polypharmacy and are at high risk for adverse drug events. Pharmacogenomic (PGx) testing, which is widely available within the VA system, identifies genetic variants that influence drug metabolism and response. Despite its availability, PGx testing remains underutilized in high-risk populations. We conducted a QI initiative at a single Chicago-based VA dialysis center to increase utilization of PGx testing and evaluate its impact on medication safety in veterans with ESKD.
Methods
PGx testing was offered to all adult patients receiving in-center HD or PD at Hines VA (n=99). Exclusions included prior liver or allogeneic bone marrow transplant, inability to consent, or refusal. After standardized education and verbal consent, testing was performed via one-time blood draw. Results were reviewed by a pharmacogenomics-trained PharmD, with recommendations documented in the electronic health record and communicated to prescribers.
Results
All 99 patients (100%) had at least one actionable genetic variant. 48% were prescribed at least one medication affected by their PGx profile. Commonly implicated medications included omeprazole (n=16), pantoprazole (n=12), atorvastatin (n=11), clopidogrel (n=9), and hydralazine (n=8). Six patients on clopidogrel were found to have CYP2C19 loss-of-function variant. This variant impairs conversion of clopidogrel to its active metabolite, reducing antiplatelet effect and increasing risk of stent thrombosis and MI. As a result, this required a change to ticagrelor following recent stent placement. Additional findings included NAT2 variants affecting hydralazine metabolism (n=6), prompting dose review, and G6PD deficiency (n=7), resulting in hematology referral.
Conclusion
Systematic PGx testing in a high-risk ESKD dialysis population is feasible and leverages an existing VA resource. Many ESKD patients have CVD and undergo PCI, making CYP2C19-guided antiplatelet selection important when considering clopidogrel. In this context, switching CYP2C19 loss-of-function carriers from clopidogrel to ticagrelor is a high-impact strategy to prevent stent thrombosis and myocardial infarction. Integrating PGx data into the electronic record provides ongoing value by informing future prescribing and enhancing medication safety. These findings support broader adoption of PGx testing as a proactive, precision-based safety approach in dialysis populations.