Kidney Week

Abstract: SA-PO0475

A Multidisciplinary Quality Improvement (QI) Project to Optimize Medication Management for Diabetic Nephropathy in Primary Care

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

• Kwon, Haneul Judy, New York City Health and Hospitals Jacobi, New York, New York, United States

Haneul Judy Kwon, PharmD

• Cartmill, Kimberly, New York City Health and Hospitals Jacobi, New York, New York, United States

Kimberly Cartmill, MD

• Nelson, Ingrid L., New York City Health and Hospitals Jacobi, New York, New York, United States

Ingrid L. Nelson, MD

• Bharati, Bishal, New York City Health and Hospitals Jacobi, New York, New York, United States

Bishal Bharati, MD

• Wagle, Abhishesh, New York City Health and Hospitals Jacobi, New York, New York, United States

Abhishesh Wagle, MD, MBBS

• Bhandari, Sanjeev, New York City Health and Hospitals Jacobi, New York, New York, United States

Sanjeev Bhandari, MD

• Rodriguez, Marcos Alejandro, New York City Health and Hospitals Jacobi, New York, New York, United States

Marcos Alejandro Rodriguez, MD

• Acharya, Anjali, New York City Health and Hospitals Jacobi, New York, New York, United States

Anjali Acharya, MD, MBBS, FASN

Background

Diabetes remains a leading cause of chronic kidney disease (CKD) worldwide. Early interventions targeting diabetic kidney disease (DKD) can significantly delay progression. Current guidelines from ADA and KDIGO recommend the use of four classes of medications to treat DKD. Despite these recommendations, most patients with diabetic nephropathy do not receive optimal medication management. We conducted a quality improvement project in the chronic disease management (CDM) clinic aiming to increase medication optimization for renoprotection in patients with preexisting DKD by 10% from baseline (Oct-Dec 2025) by Mar 2026.

Methods

Weekly patient lists from the EMR were sent to nephrologists for chart review and patient-specific recommendations. The recommendations were sent in advance to the CDM providers. The process measure was percentage of patients s with nephrology recommendations.. The outcome measure was percentage of eligible patients who had a medication change implemented for renal protection. This included starting or increasing the dose of any of the four classes of medications: ACE inhibitors or ARBs, GLP1 agonists, SGLT2 inhibitors, and/or non-steroidal MRAs. The balancing measure was wait time for nephrology appointments. Patient language preference was used as an equity lens.

Results

The percentage of patients who had a renoprotective medication intervention increased by 15%, from a median of 24% to 39%. At baseline, 18 out of 79 patients had a medication change vs 30 out of 78 patients post-PDSA. The process measure shows all eligible patients had recommendations post-intervention. The equity lens shows that non-English speaking patients had a higher rate of medication changes after implementation. The balancing measure shows that wait times for nephrology appointments improved by 19 days pre vs post intervention.

Conclusion

This pilot successfully implemented a streamlined multidisciplinary process to improve medication management for renoprotection among high risk diabetic patients. Despite our success, there were limitations. The PDSA was implemented in a safety-net primary care clinic which allows for more time to focus on diabetes management. In addition, we were unable to evaluate the impact on the progression of CKD due the short duration of the project. We plan to continue this project with further data analysis.