Abstract: FR-PO337
Improving Conformity to Diabetic Kidney Disease Clinical Guidelines
Session Information
- Diabetic Kidney Disease: Clinical Modeling, Diagnosis, Education, and More
October 25, 2024 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Diabetic Kidney Disease
- 702 Diabetic Kidney Disease: Clinical
Authors
- Piero, Nicole, University of Cincinnati, Cincinnati, Ohio, United States
- Gudsoorkar, Prakash Shashikant, University of Cincinnati, Cincinnati, Ohio, United States
- Meganathan, Karthikeyan, University of Cincinnati, Cincinnati, Ohio, United States
- Lewis, Paul, University of Cincinnati, Cincinnati, Ohio, United States
- Thakar, Charuhas V., Queen's University Belfast, Belfast, United Kingdom
Background
In the US, 31.5 million adults have chronic kidney disease (CKD), primarily due to type 2 diabetes (DM). KDIGO updated the clinical practice guidelines (CPG) for DM and CKD management, using research on sodium glucose cotransport 2 inhibitor (SGLT2i), glucagon like peptide1 receptor agonist (GLP1RA), and mineralocorticoid receptor antagonist (MRA), with angiotensin converting enzyme inhibitors and angiotensin receptor blocker (RASi).
Methods
We present a two-phase project.
Phase 1, an observational cohort on adults with type 2 DM and CKD stages 1-5, excluding those with a prior solid organ transplant or dialysis, at a tertiary academic center renal clinic in 2019. It assessed CKD stage, proteinuria, and conformity to RASi, SGLT2i, and MRA treatments. Chi-square was used to compare groups.
Phase 2 analyzed data from Aug to Oct 2022 of renal fellow clinics, using the same criteria as Phase 1. An educational session was conducted on the CPG with an algorithm for optimal prescribing CPG recommended medications. Effectiveness was assessed using pre and post questionnaires assessing knowledge of CPG and Likert scale ratings (1-5) to evaluate prescribing intent.
Results
Phase 1 (fig) identified 1330 adults with CKD and DM seen in a nephrology clinic: 75% were on RASi [89% with proteinuria, 69% without (p<0.0001)], 8% on SGLT2i [10% with proteinuria, 6% without (p=0.018)], and 22% on MRA [25% with proteinuria, 19% without (p=0.0515)]. Medication usage was lower in CKD 4/5 compared to stages 1-3 [SGLT2i 2% vs 11% (p<0.0001); RASi 70% vs 78% (p=0.0212); MRA 18% vs 24% (p=0.065)].
In Phase 2 baseline and prescription characteristics in fellow clinics was similar to phase 1. Phase 2 found that post-education answers on knowledge questions improved from 2 to 3/5. Likert scale (rating 1-5) for self-rated knowledge increased from 3.4 to 4.4. Intent to prescribe ratings rose for SGLT2i from 3.6 to 4.4, GLP1RA from 2.4 to 3.9. Confidence in the impact on guideline adherence improved from 3.6 to 4.2.
Conclusion
Our study demonstrated an implementation gap and an intervention to address it. Continued monitoring and larger scale implementation can improve conformity and patient outcomes.