Abstract: FR-PO896
Understanding Care Gaps in the CKD Clinic
Session Information
- Diversity and Equity in Kidney Health - II
November 04, 2022 | Location: Exhibit Hall, Orange County Convention Center‚ West Building
Abstract Time: 10:00 AM - 12:00 PM
Category: Diversity and Equity in Kidney Health
- 800 Diversity and Equity in Kidney Health
Authors
- Kwong, Yuenting Diana, University of California San Francisco School of Medicine, San Francisco, California, United States
- Stewart, Erik, University of California San Francisco School of Medicine, San Francisco, California, United States
- Chu, Chi D., University of California San Francisco School of Medicine, San Francisco, California, United States
- Liu, Kathleen D., University of California San Francisco School of Medicine, San Francisco, California, United States
- Lo, Lowell J., University of California San Francisco School of Medicine, San Francisco, California, United States
Background
Use of renin-angiotensin-aldosterone system inhibitors (RAASi) and sodium-glucose co-transporter 2 inhibitors (SGLT2i) in patients with stage 2-4 chronic kidney disease (CKD) and albuminuria can reduce adverse outcomes. Understanding care gaps is necessary for better implementation of guideline concordant care.
Methods
In a single-site academic nephrology practice, we performed a cross-sectional analysis to determine the proportion of current RAASi and SGLT2 use in patients with CKD stage 2-4 with urine albumin-to-creatinine ratio (ACR) ≥ 30mg/g (i.e. moderate to severe albuminuria). We assessed for potential gender and racial disparities in the prescription of RAASi and SGLT2i using Pearson's χ2 analysis.
Results
Of 2458 adults with stage 2-4 CKD, 2046 (83%) had ACR measurements within the last 3 years and 1,281 (62%) of the ACR measurements indicated moderate to severe albuminuria. Among these 1,281 patients, RAASi use was observed in 66% of patients and SGLT2i use was observed in 18.6% of patients. Gender disparities were not observed in RAASi use but SGLT2i use was less common among men. Racial differences were observed with Asian patients having the highest rate of RAASi and SGLT2i prescriptions (76% and 28%, respectively) while White patients had lowest use of RAASi (60%) and Black patients had the lowest use of SGLT2i (12%).
Conclusion
Care gaps in RAASi and SGLT2i use can be systemically identified in nephrology clinic and may inform panel management strategies for increasing guideline-concordant care. Factors underlying differences in prescription patterns along gender and racial categories (e.g. patient perception/tolerance/insurance coverage of medications) require further investigation.
Gender and Racial Differences in RAASi and SGLT2i Use Among Patients with Moderate to Severe Albuminuria
| Gender Disparities | Racial/Ethnicity | |||||||
| Male | Female | p-value | White | Black | Asian | Other | p-value | |
| N= | 524 | 756 | 554 | 137 | 367 | 212 | ||
| RAASi use (%) | 68 | 65 | 0.31 | 60 | 67 | 76 | 62 | 0.31 |
| SGLT2i use (%) | 15 | 21 | <0.01 | 13 | 12 | 28 | 20 | <0.01 |