#1875 Physician-directed nudge for glycemic and lipid management in older patients with glomerulonephritis treated with immunosuppressants

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Abstract Background and Aims Glomerulonephritis and its treatment may be associated with cardiometabolic disease. Hence, optimizing glycemic and lipid control is important to reduce adverse health outcomes. We implemented an electronic medical records (EMR)-based physician prompt to nudge nephrologists on guideline-based glycemic and lipid optimization. We aimed to evaluate the impact of the prompt on glycemic and lipid management among older adults with glomerulonephritis receiving immunosuppressive therapy. Method This was a single-center, single-arm, implementation study with a pre-post design. We included adults ≥40 years old with active glomerulonephritis treated with immunosuppressants who had received the physician prompt as part of the ConFIRM (Cardiovascular, Infection and Frailty Risk in Older Adults with Immune-Mediated Renal Disease treated with Immunosuppressant: Recognition, Intervention and Self-Management) program. Demographic and clinical data at 6-monthly intervals were obtained from the EMR. We compared the prevalence of glycemic and lipid evaluation during follow-up visits before and after the intervention using mixed effects logistic regression models to account for variability across patients and repeated measures over time. The models adjusted for age, estimated glomerular filtration rate (eGFR), urine protein-to-creatinine ratio (UPCR), and treatment with prednisolone and calcineurin inhibitor. Results Among 137 patients with 856 visits, we compared 478 visits between Jan 2021 and June 2024 before intervention, and 378 visits between July 2022 and December 2024 after intervention. The median age at the visits was 55 (interquartile range: 48, 68) years and 58 (48, 69) years in the pre- and post-intervention groups, respectively. Table 1 shows that age, kidney function and degree of proteinuria were similar in the two groups. Glycemic evaluation was 51.8% pre-intervention and 70.0% post-intervention (unadjusted odds ratio [OR] 2.56, 95% confidence interval [CI]: 1.66–3.07). Fasting glucose was evaluated in 22.2% pre-intervention and 44.6% post-intervention, while HbA1c was evaluated in 44.7% pre-intervention and 52.5% post-intervention. Table 2 shows that glycemic evaluation was significantly associated with the intervention (adjusted OR 2.10, 95% CI: 1.52–2.90, P < 0.001), lower eGFR (adjusted OR 0.99 per 1 mL/min/1.73 m² increase, 95% CI: 0.98–0.998, P = 0.02) and prednisolone use (adjusted OR 1.65, 95% CI: 1.11–2.45, P = 0.01). Lipid evaluation was 43.6% pre-intervention and 43.2% post-intervention. Lipid evaluation was not associated with the intervention (adjusted OR 0.91, 95% CI: 0.67–1.23, P = 0.55), nor with age, kidney function, proteinuria or use of prednisolone or calcineurin inhibitor. Conclusion A physician-directed nudge significantly increased glycemic evaluation but not lipid evaluation in older patients with glomerulonephritis treated with immunosuppressants.

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