Abstract: SA-PO0463
Contemporary Use of Guideline-Directed Medical Therapy in US Adults with Advanced CKD and High Risk of Cardiovascular Events
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
- Tajerian, Amin, Baylor Scott & White Research Institute, Dallas, Texas, United States
- Priest, Elisa, Baylor Scott & White Research Institute, Dallas, Texas, United States
- Mohottige, Dinushika, Icahn School of Medicine at Mount Sinai, New York, New York, United States
- McCowan, Precious, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States
- Butler, Javed, Baylor Scott & White Research Institute, Dallas, Texas, United States
- Khan, Muhammad Shahzeb, Baylor Scott & White Research Institute, Dallas, Texas, United States
- Green, Jamie Alton, Geisinger Medical Center, Danville, Pennsylvania, United States
- Jalal, Diana I., University of Iowa Health Care, Iowa City, Iowa, United States
- Fisher, Molly, Albert Einstein College of Medicine, New York, New York, United States
- Ozieh, Mukoso N., Medical College of Wisconsin, Milwaukee, Wisconsin, United States
- Chang, Tara I., Medical College of Wisconsin, Milwaukee, Wisconsin, United States
- Jaar, Bernard G., Johns Hopkins University, Baltimore, Maryland, United States
- Dember, Laura M., University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, United States
- Flythe, Jennifer E., The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States
- Shafi, Tariq, Baylor Scott & White Research Institute, Dallas, Texas, United States
Background
Patients with all stages of CKD are at a higher risk of cardiovascular (CV) events and death than experiencing kidney failure (KF), with the highest CV risk in those with advanced CKD (aCKD). We sought to evaluate the contemporary use of guideline-directed medical therapy (GDMT) for CV disease in patients with aCKD.
Methods
We used EHR data from 30 US health systems (Truveta database) to identify adults (≥18 years) with aCKD (eGFR<30 mL/min/1.73m2; not receiving kidney replacement therapy) who had visits between 1/1/2024 and 12/31/2025. We estimated the 2-year risk of CV events and death (9-variable CKD-PC aCKD Risk Tool) and the 2-year risk of KF (4-variable KF Risk Equation). We evaluated GDMT use across CV risk strata.
Results
We identified 106,383 individuals with aCKD; median age was 77 years, 58% were female, and 24% were Black (Table). The median 2-year risk of 19.7% for CV events and 19% for death, both markedly exceeded the risk of KF (9.6%). Use of GDMT was lower than expected across all CV risk strata. SGLT2i use ranged from 11% to 17%, RASi use ranged from 35% to 39%, and statin use ranged from 35% to 56%. Even among those with diabetes (N=65,680, 62%), a population with strong guideline indications for GDMT, prescriptions remained low: 21% received SGLT2i, 40% RASi, 15% GLP-1 RAs, and 54% statins.
Conclusion
In patients with aCKD, the risks of CV events and death exceed the risk of KF. Despite this high-risk profile, use of GDMT remains suboptimal. There is a need to enhance patient and provider education and optimize treatment to prevent CV events and improve survival for patients with aCKD, while also preparing for future kidney replacement therapy.
Advanced CKD Population Characteristics stratified by CV Risk
| Characteristic | Overall N = 106,383 | CV Risk <10% N = 24,941 | CV Risk 10-30% N = 58,019 | CV Risk >30% N = 23,423 | P-value |
| Age, years | 76.9 (67.8, 84.2) | 69.1 (57.8, 78.2) | 77.2 (68.7, 84.2) | 81.6 (75.5, 87.3) | <0.001 |
| Female sex | 61,529 (58%) | 15,810 (63%) | 34,391 (59%) | 11,328 (48%) | <0.001 |
| Black Race | 25,400 (24%) | 6,138 (25%) | 13,166 (23%) | 6,096 (26%) | <0.001 |
| Urine albumin-creatinine ratio, mg/g | 221 (49, 918) | 120 (28, 697) | 140 (40, 607) | 718 (272, 1,777) | <0.001 |
| Most recent eGFR, mL/min/1.73 m2 | 23.5 (18.4, 26.8) | 24.0 (18.4, 27.2) | 24.4 (19.9, 27.2) | 20.4 (15.8, 24.4) | <0.001 |
| 2-year Kidney Failure Risk, % | 9.6 (5.6, 19.9) | 10.2 (5.2, 24.5) | 8.0 (5.1, 15.6) | 14.0 (8.3, 25.6) | <0.001 |
| 2-year Death Risk, % | 19.0 (11.9, 28.6) | 9.7 (6.5, 13.7) | 18.6 (13.5, 24.9) | 34.8 (27.9, 43.5) | <0.001 |
| 2-year Cardiovascular Event Risk, % | 19.7 (10.5, 28.8) | 6.5 (4.7, 8.3) | 20.0 (14.3, 25.0) | 35.3 (32.4, 39.4) | <0.001 |
| Current RASi use | 39,748 (37%) | 8,703 (35%) | 22,416 (39%) | 8,629 (37%) | <0.001 |
| Current SGLT2i use | 16,642 (16%) | 2,772 (11%) | 9,950 (17%) | 3,920 (17%) | <0.001 |
| Current GLP-1 RA use | 10,430 (10%) | 2,515 (10%) | 5,967 (10%) | 1,948 (8%) | <0.001 |
| Current Statin use | 51,173 (48%) | 8,673 (35%) | 29,344 (51%) | 13,156 (56%) | <0.001 |
Median (Q1, Q3) or Frequency (%)