New prognostic test may help improve hypertension in patients with diabetic kidney disease
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Key takeaways:
- KidneyIntelX is a prognostic test that incorporates machine learning and predictive biomarkers.
- Clinical pharmacists provided interventions through remote patient monitoring.
LONG BEACH, Calif. — A prognostic kidney test and medication management in patients with diabetic kidney disease was tied to use of cardiorenal protective medications and improved hypertension control, according to data presented here.
Researchers led by Catherine Liu, PharmD, of the Mount Sinai Health System in New York, found using the KidneyIntelX test jointly with a centralized telehealth clinical pharmacy program improved outcomes for patients with type 2 diabetes and G1-3b chronic kidney disease.
“Our study was basically utilizing a new blood test that is designated for patients who have type 2 diabetes and early stage kidney disease,” Liu told Healio at the National Kidney Foundation Spring Clinical Meetings. “So, it is really evaluating which of those patients are going to be at the greatest risk of kidney progressions reaching end-stage renal disease in the next 5 years.”
KidneyIntelX is a prognostic test that incorporates machine learning algorithms and predictive biomarkers and clinical variables to generate patient-specific risk assessment for kidney function decline during a 5-year period. The study, conducted from January 2022 to August 2023, involved 489 patients who were identified as intermediate or high risk by the KidneyIntelX program and actively managed through telehealth visits across 62 clinics.
Of the actively managed cohort, median age was 63 years, 56% were women and 29% identified as Black. Baseline median eGFR was 76 mL/min/1.73m2, urine albumin-creatinine ratio was 121 mg/g and HbA1c was measured at 8%.
Clinical pharmacists provided interventions such as hypertension management through remote patient monitoring, recommendations to improve diabetes and renal protective medications optimization including angiotensin-converting enzyme inhibitors (ACEIs)/ angiotensin receptor blockers (ARBs), SGLT2 inhibitors and glucagon-like peptide-1 receptor agonists (GLP-1Ras).
Overall, 22% of patients were considered at high risk for CKD progression, while 78% had an intermediate risk. Before testing, 50% of patients were on SGLT2 inhibitors and/or GLP-1RA therapy, according to the study. That number increased to nearly 70% post-testing.
After testing, 24% of high-risk patients and 17% of intermediate-risk patients received new or increased doses of ACEI/ARB prescriptions. In addition, 250 patients were enrolled in a pharmacist-led hypertension remote patient monitoring program. This resulted in a median decrease in systolic blood pressure from 146 mm Hg to 132 mm Hg and a median decrease in diastolic blood pressure from 83 mm Hg to 78 mm Hg after 12 months, according to results.
The results support approaches by health care systems to elevate early stage diabetic kidney disease management and patient outcomes via digital health services, according to the researchers.
“Ideally, all of our patients are going to have perfect blood pressures and perfect A1cs,” Liu said. “But ultimately, we know that there are some patients that require higher touch points that are going to be at higher risk. So, it is really about us understanding which patients do we prioritize and stratify to make sure that those are the patients that are really getting the care that they need because they are at higher risk of end-stage renal disease.”
Editor’s note: The article was updated on July 29, 2024, to correct Dr. Liu’s degrees as well as provide additional information to the financial disclosure statement.
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Liu C, et al. Paper 336. Presented at: NKF Spring Clinical Meetings; May 14-18, 2024; Long Beach, Calif.
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