Kidney Week

Abstract: SA-PO0461

Guideline-Directed Medical Therapy Use in Patients with Diabetes and CKD in a Diverse Urban Cohort

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

• 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

• Hariharan, Nithesh, New York City Health and Hospitals Jacobi, New York, New York, United States

Nithesh Hariharan, MD

• Tekalign, Rediet, New York City Health and Hospitals Jacobi, New York, New York, United States

Rediet Tekalign, MD, MPH

• Oduro, Anna, New York City Health and Hospitals Jacobi, New York, New York, United States

Anna Oduro, MBChB

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

Anjali Acharya, MD, MBBS, FASN

Background

Chronic kidney disease (CKD) disproportionately affects patients with type 2 diabetes mellitus (T2DM) and is a major predictor of cardiovascular health. Guideline-Directed Medical Therapy (GDMT) including ACE inhibitors (ACEi), angiotensin receptor blockers (ARB), sodium-glucose cotransporter-2 inhibitors (SGLT2i), glucagon-like peptide-1 receptor agonist (GLP1RA), and non-steroidal mineralocorticoid receptor antagonist (nsMRA) has transformed the management of diabetic CKD. Despite established GDMT recommendations, its implementation has been poor.

Methods

This is a retrospective study of 5,406 patients with T2DM at an urban academic health system, out of which 1,167 had confirmed CKD and formed the primary cohort. Prescribing rates for 4 GDMT medication classes were assessed by CKD stage (G1–G5), overall and by race/ethnicity. Multivariable logistic regression was performed for each GDMT outcome, adjusting for age, sex, CKD stage (G1 referent), and race/ethnicity (White referent).

Results

The cohort's mean age was 68±13 years (55% female) with 42% Hispanic and 39% Black patients. Mean eGFR was 54±29 ml/min/1.73m² and 20% had advanced CKD (G4/G5). Overall prescribing rates were: ACEi/ARB 77.6%, SGLT2i 52.7%, and GLP1RA 42.8% with no one on nsMRA. On multivariable regression, older age was independently associated with lower odds of GLP1RA prescribing (OR 0.97/year, p<0.001), with no significant effect on ACEi/ARB (p=0.39) or SGLT2i (p=0.49). GLP1RA prescribing declined with advancing CKD stage (58.2% in G1 vs. 34.8% in G3b), and G3b independently predicted lower odds of GLP-1RA prescription (OR 0.56, p=0.041). Race/ethnicity was not an independent predictor of prescribing for any GDMT class after adjustment. Among those who were not prescribed ACEi/ARB, most did not have documented reason (6.3%) while ESRD (2.3%) and hyperkalemia (1.8%) were other top reasons. Among those who were not prescribed SGLT2i, majority did not have documented reason (17.2%) while 6.6% had ESRD and 4.5% had genitourinary infections.

Conclusion

GDMT underutilization across all 4 pillars was evident in this study. Older age and advanced CKD stage (G3b) were independently associated with lower GDMT prescribing highlighting a treatment gap not explained by race/other comorbidity. Interventions to improve their usage and therapeutic inertia with multidisciplinary care is the need of the hour to address these treatment gaps.