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Abstract: TH-PO255

Predictors of Persistent Medication Use in Diabetic Kidney Disease (DKD)

Session Information

Category: Diabetic Kidney Disease

  • 602 Diabetic Kidney Disease: Clinical

Authors

  • Nicholas, Susanne B., University of California Los Angeles, Los Angeles, California, United States
  • Daratha, Kenn B., Providence St Joseph Health, Spokane, Washington, United States
  • Alicic, Radica Z., Providence St Joseph Health, Spokane, Washington, United States
  • Jones, Cami R., Providence St Joseph Health, Spokane, Washington, United States
  • Kornowske, Lindsey M., Providence St Joseph Health, Spokane, Washington, United States
  • Fatoba, Samuel T., Bayer AG, Leverkusen, Nordrhein-Westfalen, Germany
  • Kong, Sheldon X., Bayer AG, Leverkusen, Nordrhein-Westfalen, Germany
  • Singh, Rakesh, Bayer AG, Leverkusen, Nordrhein-Westfalen, Germany
  • Norris, Keith C., University of California Los Angeles, Los Angeles, California, United States
  • Tuttle, Katherine R., Providence St Joseph Health, Spokane, Washington, United States

Group or Team Name

  • CURE-CKD
Background

Angiotensin-converting enzyme inhibitors (ACEi) or angiotensin II receptor blockers (ARB) have been the standard-of-care for DKD for >2 decades, yet few patients receive them. The aim of this study was to identify predictors of persistent use of medications used to treat DKD.

Methods

From the Providence and UCLA Health Center for Kidney Disease Research, Education, and Hope Registry (CURE-CKD) of electronic health records, we derived demographic, clinical, and prescription medication data for patients ≥20 years old with DKD. ACEi/ARB, sodium-glucose cotransporter-2 inhibitor (SGLTi), and glucagon-like peptide receptor agonist (GLP-1 RA) use was determined at baseline and over time during 2019-2020. A multiple logistic regression model was created for each medication class to predict persistent medication use (≥90 days).

Results

Patients with DKD (N=21,658) were 50% women, 70±13 (mean±SD) years of age and White (UCLA: 50%, Providence: 69%). Baseline measures were 2021 CKD-EPI eGFR of 58±22 mL/min/1.73 m2, urine albumin-to-creatinine ratio of 66 (45-113; median, IQR) mg/g, and systolic blood pressure of 131±16 mm Hg. Median follow-up time was 1 year during 2019-2020. Baseline versus persistent use of ACEi/ARBs were 66% versus 36%; SLGT2i, 5% versus 4%; and GLP-1 RA, 6% versus 5%, respectively. Longer follow-up time predicted higher, while lack of commercial insurance predicted lower, persistent use of each medication class. Positive predictors of persistent ACEi/ARB use were men, non-White race, hypertension, higher eGFR, other medication use, and longer follow-up time (Figure).

Conclusion

In typical patients with DKD treated in contemporary clinical practice, use of ACEi/ARB, SGLT2i, and GLP-1 RA is suboptimal and wanes over a short period of time with disparities in persistent use for those without commercial insurance. Inclusive strategies are needed to implement and maintain optimal DKD therapy for all groups of people.

Predictors of persistent ACEi/ARB use in DKD, 2019-2020

Funding

  • Other NIH Support – Bayer