Kidney Week

Abstract: SA-PO1131

Real-World Evaluation of Best Practice Patterns in CKD Management

Session Information

• CKD: Patient-Oriented Care and Case Reports
  October 26, 2024 | Location: Exhibit Hall, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: CKD (Non-Dialysis)

• 2302 CKD (Non-Dialysis): Clinical, Outcomes, and Trials

Authors

• Chua, Yan Ting, National University Hospital, Singapore, Singapore, Singapore

Yan Ting Chua, MBBS

• Ngoh, Clara Lee Ying, National University Hospital, Singapore, Singapore, Singapore

Clara Lee Ying Ngoh, MBChB

• Khatri, Priyanka, Alexandra Hospital, Singapore, Singapore

Priyanka Khatri, MBBS

• Rastogi, Shilpa, Ng Teng Fong General Hospital, Singapore, Singapore

Shilpa Rastogi, MD

• Koh, Sky Wei Chee, National University Polyclinics, Singapore, Singapore

Sky Wei Chee Koh, MBChB

• Ma, Valerie, National University Health System, Singapore, Singapore, Singapore

Valerie Ma, RN

• Goh, Wui Heng, National University Health System, Singapore, Singapore, Singapore

Wui Heng Goh

• Chua, Horng-Ruey, National University Hospital, Singapore, Singapore, Singapore

Horng-Ruey Chua, MBBS, FASN

Background

The incidence of kidney failure continues to rise amid an evolving landscape in chronic kidney disease(CKD) management, with improved therapeutics that prompted a series of practice guidelines. However, real-world uptake of CKD therapeutics, against a backdrop of polypharmacy, is unclear. We used our information systems to track adoption of best CKD practices in a regional healthcare cluster.

Methods

We performed a multicenter ambi-directional cohort study of patients with CKD, aged≥21, from 7 primary care institutions and 3 acute hospitals. We extracted quarterly anonymized demographics, laboratory and prescription data from electronic health records from March 2022 to March 2024 to evaluate aggregated measures in CKD care. We defined CKD by ICD-10 diagnosis codes and ≥2 estimated glomerular filtration rate(eGFR)≥90 days apart of <60mL/min/1.73m². We excluded patients with kidney failure.

Results

We studied 34,217 patients. Mean age was 72±12years. Clinicians did not monitor 33% of patients for albuminuria or proteinuria. Less than half of diabetic patients aged<80 with CKD G1-3b achieved Hba1c<7%. Of patients aged<80 with eGFR<60, diabetes, ischemic heart disease, stroke or peripheral vascular disease, 71% received statins; 69% had lipids measured, of whom 72% achieved low-density lipoprotein<2.6mmol/L. Use of angiotensin II receptor blockers(ARB) or angiotensin-converting enzyme inhibitors(ACEi) in albuminuric patients was 74%; only 40% received ceiling doses despite 4% prevalence of hyperkalemia and 4% with mean systolic blood pressure<110mmHg. Penetrance of sodium-glucose co-transporter-2 inhibitors(SGLT2i) increased from 21% to 40% among albuminuric patients during the study period. Of patients aged<80 with albuminuric CKD G1-3b, 21% received ACEi/ARB at≥50% ceiling doses, SGLT2i and statins; fewer non-diabetic vs diabetic patients received SGLT2i (12% vs 49%,p<0.01) or statins (65% vs 83%,p<0.01). In contrast, patients with obesity or worse albuminuria were more likely to be on a combination of ACEi/ARB, SGLT2i and statins.

Conclusion

We visualize a disconnect between CKD practice guidelines and their real-world adoption. We will examine a systems approach to scale up population-level CKD management in patients yet to be optimized with evidence-based therapeutics, such as for non-diabetic CKD.

Funding

• Commercial Support – AstraZeneca. The pharmaceutical company was not involved in the conduct, analysis or reporting of the study