Electronic Health Record-Based Population Health Management to Optimize Care in CKD: Kidney CHAMP Randomized Clinical Trial

Background: Large gaps in clinical care in patients with chronic kidney disease (CKD) lead to poor outcomes. We tested the effectiveness of an electronic health record (EHR)-based population health management (PHM) intervention at reducing CKD progression and improving evidence-based care in high-risk CKD. Methods: In a pragmatic cluster randomized clinical trial, we randomized 101 primary care practices to either intervention or usual care, and enrolled patients aged 18-85 years with estimated glomerular filtration rate (eGFR) <60 ml/min/1.73m2, with high risk of CKD progression and not seeing a nephrologist. Multifaceted intervention included nephrology e-consult, pharmacist-led medication management, and CKD education. Primary outcome was time to ≥40% reduction in eGFR or End Stage Kidney Disease. Results: Among 1,596 patients with mean age 74±9 years, 58% were females, 8% were Black, and mean eGFR 36.8±7.9 ml/min/1.73m2. Over a median follow-up of 17.4 months, there was no significant difference in rate of primary outcome between the two arms (adjusted hazards ratio 0.99, 95% CI 0.69, 1.42; P=0.94). Angiotensin converting enzyme inhibitor/Angiotensin receptor blocker (ACEi/ARB) exposure was more frequent in intervention arm compared to control (rate ratio 1.22, 95%CI 1.04 to 1.44, P=0.018). There was no difference in secondary outcomes of hypertension control and exposure to unsafe medications, or adverse events between the arms. Conclusions: Among patients with moderate to high-risk CKD, a multi-faceted EHR-based PHM intervention resulted in more exposure days to ACEi/ARB but did not reduce risk of CKD progression or hypertension control versus usual care. Several COVID pandemic related factors likely contributed to null findings in our study. Funding: NIDDK Support