Kidney Week

Abstract: SA-PO0464

Use of Guideline-Directed Medical Therapy in Patients with Diabetes, CKD, and Heart Failure: A Single-Center Study Based on CKD Stage and Heart Failure Phenotype

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

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

Abhishesh Wagle, MD, MBBS

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

Bishal Bharati, MD

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

Nithesh Hariharan, MD

• 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

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

Anna Oduro, MBChB

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

Rediet Tekalign, MD, MPH

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

Anjali Acharya, MD, MBBS, FASN

Background

Diabetes, Chronic Kidney Disease (CKD) and Heart Failure (HF) often coexist, have a complex interaction and carry a high mortality. And CKD compounds risk of Heart Failure. Despite landmark trials showing benefits of guideline-directed medical therapy (GDMT) in HF, prescribing gaps persist.

Methods

We conducted a retrospective cross-sectional chart review in an inner-city Hospital in the Bronx from Dec 2022–July 2025. Diabetics with KDIGO criteria for CKD were included. Demographics, CKD stage, HF phenotype (HFrEF/HFpEF), use and dosing of 5 GDMT classes of drugs (ACEi/ARB/ARNI, SGLT2i, MRA, GLP-1RA, beta-blockers)and documented barriers to prescribing were collected by chart review. Multivariable logistic regression identified independent predictors of GDMT prescription, adjusting for age, sex, CKD stage and HF status/phenotype.

Results

Of 5405 patients screened, 1,167 had CKD with mean age of 68±13y; 54.8% female; 41.6% Hispanic/Latinx, 38.6% Black/African American; 211 (18.1%) had HF- 82(38.8%) withHFrEF, 127(60.1%) with HFpEF. HF prevalence rose from 25.5% in CKD stage G3b to 32.2% in Stage G5. Use of GDMT was as follows: ACEi/ARB 77.6%, beta-blocker 59.5%, SGLT2i 52.7%, GLP-1RA 42.7%, MRA 15.0%. 5.1% received quadruple therapy, and 2.2% received all 5 classes of drugs. CKD+HF patients had higher GDMT use-median 3 vs. 2 [IQR 1–3] for CKD +No HF). 25.8% of CKD +HF patients on ACEi/ARB/ARNI and 26.4% on SGLT2i were sub optimally dosed. HF independently predicted MRA (OR 6.15, 95%CI 3.96–9.65), beta-blocker (OR 8.38, 95%CI 4.99–15.0), and SGLT2i use (OR 1.68, 95%CI 1.22–2.34; all p<0.01). HFrEFshowed the strongest associations for MRA (OR 9.15), beta-blocker (OR 9.83), and SGLT2i (OR 2.29; all p<0.01). The leading barrier to ACEi/ARB non-use were absence of documented reason in 73 (6.3%), ESRD 27(2.3%), Hyperkalemia 21(1.8%). For SGLT2i non- use, 208(17.8%) had no documented reason, 77(6.6%) had ESRD, 52(4.5%) had genitourinary infections.

Conclusion

Our study showed that GDMT use in DKD with heart failure remains suboptimal. Clinical inertia and concern for hyperkalemia were the predominant barriers. These results underscore the urgent need for improving implementation of GDMT in this high-risk population. This can be achieved by multidisciplinary co-management of HF patients with Diabetic CKD.