WCN23-0175 Improving SGLT-2 prescribing in CKD patients at a regional English hospital: A quality improvement project

Introduction: A recent trial in the New England Journal of Medicine reported significantly improved cardiovascular mortality, eGFR decline rate and progression to end stage renal failure in patients with chronic kidney disease (CKD) and albuminuria taking dapagliflozin versus placebo. The improvement was reported in both diabetic and non-diabetic patients. Subsequently, the National Institute for Health and Care Excellence (NICE) updated its guidelines in March 2022 recommending SGLT-2 inhibitors for patients with CKD and either diabetes or significant albuminuria (albumin-to-creatinine ratio [ACR] of 22.6 mg/mmol or more). The aim of this quality improvement project was to identify and improve the compliance rate of SGLT-2 prescribing in appropriate patients in our hospital. Method(s): We reviewed data for patients with CKD who were discharged from 09/03/2022 to 16/03/2022 from our institution (a district general hospital in England). We assessed whether they were appropriately prescribed SGLT-2 inhibitors based on NICE guidelines. Patients with an allergy or contraindications to SGLT-2s were excluded. Our primary outcome measure was the percentage of patients correctly prescribed dapagliflozin. We then performed an intervention to increase the rate of compliance. This consisted of stakeholder education in secondary care. In selected patients, we advised colleagues to prescribe dapagliflozin or to educate primary care to initiate treatment via discharge summaries. This was achieved via presentations at a local Grand Round meeting, junior doctor teaching sessions and educational posters in clinical areas. Subsequently, we re-reviewed the appropriate prescription rate from 25/04/2022 to 01/05/2022. Result(s): The proportion of eligible patients correctly prescribed an SGLT-2 inhibitor in the pre-intervention group was 7% (1/14). This improved in the post-intervention group to 26% (5/19). There were 35 patients in total who were excluded due to an untested urinary albumin-creatinine ratio. Conclusion(s): This quality improvement project has reported low compliance rates with SGLT-2 prescriptions in eligible patients in our institution. However, there was a noticeable increase in compliance following a local education program. There is clearly significant further scope for improvement. Causes for the shortfall may include: a lack of knowledge in primary care, the relatively recent publication of guidelines and the fact that not all eligible patients are reviewed by nephrologists. These findings show the power of education in enacting evidence-based change in a healthcare setting. Extrapolating these findings, it is likely that more stakeholder education is required nationally in primary and secondary care. The involvement of diabetic specialist nurses is a potential avenue to increase prescription rates in patients with diabetic nephropathy. Further work with primary care is also needed to increase the rates of ACR measurements in CKD patients as it is crucial to guide management and prognosis. No conflict of interest

Citation

Brown A., Macinnes P., Wales E. & Ffrench R. (2023). WCN23-0175 Improving SGLT-2 prescribing in CKD patients at a regional English hospital: A quality improvement project. Kidney International Reports, 8(3 Supplement), S188. https://doi.org/10.1016/j.ekir.2023.02.419

DOI

10.1016/j.ekir.2023.02.419

URI

https://hdl.handle.net/20.500.14709/1135

Usage rights

CC BY-NC-ND 4.0

License

https://creativecommons.org/licenses/by-nc-nd/4.0/