BACKGROUND Gaps in guideline-concordant care for chronic kidney disease (CKD) lead to poor outcomes. The Kidney Coordinated HeAlth Management Partnership (K-CHAMP) cluster randomized trial tested the effect of a population health management intervention versus usual care on CKD progression and evidence-based care delivery in the primary care setting. METHODS K-CHAMP included adults aged 18-85 years with eGFR <60 mL/min/1.73m2 and moderate-high risk of CKD progression who were not seeing a nephrologist. The multi-faceted intervention included nephrology e-consult, pharmacist-led medication management, and patient education. In this post-hoc analysis, we evaluate the effectiveness of K-CHAMP on guideline-concordant care processes (blood pressure and glycemic control, annual albuminuria testing), and medication exposure days (ACEi/ARB, moderate-high intensity statin, SGLT-2i, GLP-1RA). Given multiplicity of outcomes, Benjamini-Hochberg method was used to control false discovery rate (FDR). RESULTS All 1,596 (754 intervention, 842 usual care) enrolled patients (mean age 74±9 years, eGFR 37±8 mL/min/1.73m2, 928 (58%) female, 127 (8%) Black) were analyzed. After a median 17-month follow-up, intervention arm patients had significantly higher exposure days per year to SGLT-2i (56 vs 32 days, relative benefit 1.72, 95% CI 1.14-2.30) and GLP-1RA (78 vs 29 days, relative benefit 2.65, 95% CI 1.59-3.71) compared to usual care in adjusted analysis. At study initiation in 2019, similar proportion of patients were prescribed SGLT-2i and/or GLP-1RA in intervention and control arm (8% vs 6% respectively, rate ratio 1.23, 95% CI 0-2.99), but by 2022, prescription of these medications was significantly higher in intervention arm (44% vs 27% respectively, rate ratio 1.63, 95% CI 1.32-1.94). There was no significant difference in any process measures or exposure days to ACEi/ARB in patients with albuminuria or moderate-high intensity statin. CONCLUSIONS K-CHAMP was effective in accelerating implementation of SGLT-2i and GLP-1RA but did not increase ACEi/ARB in patients with albuminuria or moderate-high intensity statin use, or improve blood pressure control, glycemic control, or albuminuria testing in individuals with CKD in the primary care setting.

中文翻译：

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CKD 中的人口健康管理和指南一致护理：K-CHAMP 的二次分析。


背景 慢性肾脏病 （CKD） 指南一致的护理差距导致不良结局。肾脏协调健康管理伙伴关系 （K-CHAMP） 整群随机试验测试了人口健康管理干预与常规护理对初级保健环境中 CKD 进展和循证护理提供的影响。方法 K-CHAMP 包括 18-85 岁 eGFR <60 mL/min/1.73m2 和 CKD 进展中高风险且未去看肾病科的成年人。多方面的干预包括肾脏病学电子会诊、药剂师主导的药物管理和患者教育。在这项事后分析中，我们评估了 K-CHAMP 对指南一致的护理过程（血压和血糖控制、年度白蛋白尿检测）和药物暴露天数（ACEi/ARB、中高强度他汀类药物、SGLT-2i、GLP-1RA）的有效性。鉴于结果的多重性，使用 Benjamini-Hochberg 方法控制错误发现率 （FDR）。结果 分析了所有 1,596 例 （754 例干预，842 例常规护理） 患者 （平均年龄 74±9 岁，eGFR 37±8 mL/min/1.73m2,928 例 （58%） 女性，127 例 （8%） 黑人）。中位随访 17 个月后，干预组患者每年暴露于 SGLT-2i （56 天 vs 32 天，相对获益 1.72,95% CI 1.14-2.30） 和 GLP-1RA （78 天 vs 29 天，相对获益 2.65,95% CI 1.59-3.71） 的暴露天数在调整后的分析中与常规护理相比。在 2019 年研究开始时，干预组和对照组接受 SGLT-2i 和/或 GLP-1RA 的患者比例相似（分别为 8% 和 6%，比率比 1.23,95% CI 0-2.99），但到 2022 年，干预组的这些药物处方显着更高（分别为 44% 和 27%，比率比 1.63,95% CI 1.32-1。94）. 白蛋白尿或中高强度他汀类药物患者的任何过程测量或 ACEi/ARB 暴露天数均无显著差异。结论 K-CHAMP 可有效加速 SGLT-2i 和 GLP-1RA 的实施，但不增加白蛋白尿或中高强度他汀类药物使用的 ACEi/ARB，或改善初级保健机构中 CKD 患者的血压控制、血糖控制或白蛋白尿检测。