Why the study?
Recent advances in kidney-focused GDMT have transformed CKD treatment, but translation of these breakthroughs into actual GDMT prescribing has been slow, requiring better understanding of the barriers to implementation.
Identifies four primary thematic barriers—clinical concerns, cost, polypharmacy, and variable guideline adoption—driving the underuse of guideline-directed medical therapy in patients with moderate-to-severe CKD.
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Addressing GDMT barriers may raise prescription rates in CKD; extends implementation research for cardiorenal guidelines.
Background Recent advances in kidney focused GDMT has transformed the treatment of CKD. Translation of these breakthroughs, to more GDMT prescribing, has been slower. We conducted a qualitative study integrating electronic medical record (EMR) chart review and structured clinician interviews to better understand barriers contributing to the delayed implementation of GDMT prescribing for patients with CKD. Methods We enrolled 36 individuals with CKD Stages G3A-4 who had an indication for GDMT without an active prescription, into an intensive CKD population health program. A clinical pharmacist focused on prescribing indicated GDMT and understanding the most likely barriers to non-prescription. These interviews were recorded, transcribed, and analyzed using a inductive-deductive thematic approach. Results Four major themes emerged from the chart review and thematic analysis as barriers to GDMT prescribing: (1) clinical concerns, including hyperkalemia, infections, side effects, and therapeutic inertia; (2) financial barriers, with costs influencing prescribing decisions; (3) polypharmacy and patient factors, including pill burden and patient preferences; and (4) limited awareness or variable adoption of CKD guidelines, with preference for individualized clinical judgment. Interviews highlighted complex decision-making related to patient age, fragmented care, and dispersion of prescribing responsibility across specialties. Conclusion This qualitative study provides novel insight into GDMT underuse in the CKD population, revealing underappreciated drivers of prescribing behavior. These insights, if further scaled, could bolster future implementation of GDMT for patients with CKD.
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Naing et al. (2026) studied Chronic kidney disease (CKD Stages G3A-4) (n=36). Electronic medical record chart review and structured clinician interviews within an intensive CKD population health program was evaluated on Barriers to guideline-directed medical therapy (GDMT) prescribing identified via inductive-deductive thematic analysis. EMR review and clinician interviews across 36 CKD patients revealed 4 major barrier themes to GDMT prescribing: clinical concerns, financial barriers, polypharmacy, and limited guideline adoption.
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