SAT-576 - Concordance with Kidney Disease Improving Global Outcomes (KDIGO) Pharmacologic Guidelines at Hospital Discharge Among Adults with Type 2 Diabetes Mellitus and Chronic Kidney Disease in A Tertiary Government Hospital

Background: The Kidney Disease: Improving Global Outcomes 2022 (KDIGO) recommends renin-angiotensin system (RAS) inhibitors, sodium-glucose cotransporter-2 (SGLT2) inhibitors, and statins among indicated patients to reduce kidney and cardiovascular risks in adults with type 2 diabetes mellitus (T2DM) and chronic kidney disease (CKD). However, local data on concordance with pharmacologic recommendations at hospital discharge are limited. This study aimed to determine the concordance of discharge pharmacotherapy with KDIGO 2022 recommendations among adults with T2DM and CKD admitted to a tertiary government hospital in the Philippines.

Methodology: This cross-sectional study used a retrospective chart review of adult inpatients with documented T2DM and CKD who were discharged from a tertiary government hospital between January 1, 2023, and June 30, 2025. Discharge prescriptions were assessed for concordance with KDIGO 2022 pharmacologic recommendations for RAS inhibitor therapy, SGLT2 inhibitor therapy and statin therapy among indicated patients. Univariate multivariable logistic regression was performed on patients with complete covariate data to identify the factors associated with full concordance.

Results: A total of 486 Filipino patients were included (median age 57 years [IQR 13]; 51.9% male), and 79.4% were on maintenance hemodialysis at discharge. All patients met the KDIGO criteria for RAS inhibitor therapy, and 62.8% (305/486) were prescribed RAS inhibitors. Of 157 patients (32.3%) with a KDIGO indication for SGLT2 inhibitor therapy, 55.4% (87/157) received an SGLT2 inhibitor. Nearly all patients met the KDIGO criteria for statin therapy (485/486, 99.8%), and 70.3% (341/485) were discharged on statins. Overall, 41.0% (199/486) were discharged on a regimen fully concordant with KDIGO recommendations. In univariate multivariable analysis (n=235), cardiovascular disease was associated with higher odds of concordance (adjusted OR 2.60, 95% CI 1.45 to 4.66; p=0.001), while higher eGFR was associated with lower concordance (adjusted OR 0.97 per 1 mL/min/1.73 m² increase, 95% CI 0.94 to 1.00; p=0.049).

Conclusions: Fewer than half of adults with T2DM and CKD were discharged on fully KDIGO-concordant cardiorenal pharmacotherapy, defined in this study as the receipt of all three KDIGO-recommended cardiorenal drug classes evaluated (SGLT2 inhibitor, RAS inhibitor, and statin) when clinically indicated and in the absence of documented contraindications. The underuse of these core disease-modifying agents highlights substantial gaps in evidence-based discharge prescribing and emphasizes the need for strategies to strengthen guideline adherence in this high-risk population.

Reference:
Kidney Disease Improving Global Outcomes Diabetes Work Group. KDIGO 2022 clinical practice guideline for diabetes management in chronic kidney disease. Kidney Int 2022.

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