Kidney Week

Abstract: FR-PO0287

Association of Guideline-Directed Medical Therapy and Hospitalization Risk in Patients with CKD

Session Information

• CKD: Omics, Systemic Stressors, and Targeted Pharmacotherapy
  October 23, 2026 | Location: Exhibit Hall A, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: CKD (Non-Dialysis)

• 2201 CKD (Non-Dialysis): Epidemiology, Risk Factors, and Prevention

Authors

• Tangri, Navdeep, University of Manitoba Max Rady College of Medicine, Winnipeg, Manitoba, Canada

Navdeep Tangri, MD, PhD

• Ferguson, Thomas W., University of Manitoba Max Rady College of Medicine, Winnipeg, Manitoba, Canada

Thomas W. Ferguson, MS, MSc

• Bhanushali, Gautam K., Nephrology Associates, Oak Park, Illinois, United States

Gautam K. Bhanushali, MD, FASN

• Sanchez, Gabriel, Nephrology Associates, Oak Park, Illinois, United States

Gabriel Sanchez

• Dague, Heather, Nephrology Associates, Oak Park, Illinois, United States

Heather Dague, MD

• Cipparrone, Nancy, Nephrology Associates, Oak Park, Illinois, United States

Nancy Cipparrone, MA

• Udani, Suneel M., Nephrology Associates, Oak Park, Illinois, United States

Suneel M. Udani, MD, FASN

Background

Chronic kidney disease (CKD) is associated with increased hospitalizations, cardiovascular events, kidney failure, and increased healthcare costs. Several guideline-directed medical therapies (GDMT) exist to modify the risk of these adverse outcomes, including renin-angiotensin-aldosterone system inhibitors (RAASi), sodium-glucose cotransporter-2 inhibitors (SGLT2i), with additional therapies for patients with CKD and diabetes: glucagon-like peptide-1 receptor agonists (GLP-1 RA), and non-steroidal mineralocorticoid receptor antagonists (MRA). Here, we examined the association of medication exposure with hospitalization events in patients with CKD stage G4+ enrolled in a value-based care program.

Methods

All patients enrolled in the CKCC Options program within a large US nephrology practice (Nov 2024 - Nov 2025) with available lab data (eGFR, urine ACR or PCR, and at least 7 other laboratory results required for the Klinrisk model) were included as part of a quality improvement initiative. The primary outcome was incident hospitalization, with patients censored at transplant, ESRD, death, or end of follow-up. Medication status was determined for all 4 therapies at the last visit prior to Nov 2025. Hospitalization counts were modeled using negative binomial regression, adjusted for Klinrisk risk quartile. Medication exposure was defined as a patient-level count (0 to 4) of therapies received.

Results

The cohort included 3,401 patients from 132 providers, contributing 3,296 patient-years of follow-up and 2,385 hospitalization events. Klinrisk risk quartile was strongly associated with hospitalization rate, with patients in the highest quartile experiencing a 3-fold higher hospitalization rate compared to the lowest (IRR 3.04, 95% CI 1.60-5.75, p<0.01). After adjustment for risk, each additional medication class was associated with a 26% lower hospitalization rate (IRR 0.74, 95% CI 0.68-0.80, p<0.01), reflecting a graded dose-response. The GDMT-hospitalization association was consistent across Klinrisk risk quartiles (interaction p=0.29).

Conclusion

In patients with CKD stage G4+, both Klinrisk-defined risk and medication intensity were associated with hospitalization. High risk patients had a higher rate of hospitalization and increased medication intensity was associated with an attenuation of this risk. A risk-based medication strategy can optimize patient and health economic outcomes.

Funding

• Commercial Support – Klinrisk Inc, AstraZeneca Inc.