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The following is a summary of “Pragmatic Trial of Hospitalization Rate in Chronic Kidney Disease,” published in the April 2024 issue of Nephrology by Vazquez et al.

People with chronic kidney disease, type 2 diabetes, and hypertension face risks, but there is a gap in extensive trials testing treatments that follow guidelines to cut down on death and problems.

Researchers conducted a prospective study verifying if guideline-directed therapy helps CKD people with type 2 diabetes. 

In this open-label, cluster-randomized trial, they assigned 11,182 patients with the kidney-dysfunction triad who were being treated at 141 primary care clinics either to receive an intervention that used a personalized algorithm (based on the patient’s electronic health record [EHR]) to identify patients and practice facilitators to assist providers in delivering guideline-based interventions or to receive usual care. The primary outcome was hospitalization for any cause at 1 year. Secondary outcomes included emergency department visits, readmissions, cardiovascular events, dialysis, and death.

The results showed that 71 practices with 5,690 patients, were assigned to the intervention group, and 70 practices, with 5,492 patients, were assigned to the usual care group. In the intervention group, patients were hospitalized at 20.7% (95% CI, 19.7 – 21.8). Meanwhile, the usual-care group’s hospitalization rate was 21.1% (95% CI, 20.1 – 22.2). The difference between the groups was only 0.4%, P=0.58). The risks of comorbidities, dialysis, and morbidity were similar in the two groups with similar risk of adverse events, except for acute kidney injury, which was observed more in patients with intervention groups (12.7% vs. 11.3%).

Investigators concluded that in this pragmatic trial involving patients with the triad of chronic kidney disease, type 2 diabetes, and hypertension, the use of an EHR-based algorithm and practice facilitators embedded in primary care clinics did not translate into reduced hospitalization at 1 year.

Source: nejm.org/doi/full/10.1056/NEJMoa2311708