Importance:Sodium-glucose cotransporter 2 (SGLT2) inhibitors have been shown to improve clinical outcomes for patients with type 2 diabetes and chronic kidney disease (CKD), yet their uptake in clinical practice remains low. Objective:To assess whether pharmacist-led outreach would be associated with increased initiation of SGLT2 inhibitor use among patients with type 2 diabetes and CKD. Design, Setting, and Participants:In this quality improvement study, eligible patients identified through an established Veterans Affairs (VA) diabetes dashboard were divided into 2 groups based on the last digit of their Social Security number, creating a pseudorandomized treatment assignment. The study was conducted from February 2022 through April 2024 in 8 VA health systems in the midwestern US. Veterans with CKD (estimated glomerular filtration rate ≥25 and <60 mL/min/1.73 m2) and type 2 diabetes were included. Patients were excluded if they were already prescribed an SGLT2 inhibitor or had an SGLT2 inhibitor allergy, type 1 diabetes, or contraindicating conditions. Intervention:Eligible patients in the intervention group were mailed a letter describing the benefits of SGLT2 inhibitors. Patients were then scheduled for a 30-minute telephone visit with a pharmacist. Patients determined to be a candidate for the medication were prescribed empagliflozin. The usual care group received no targeted outreach but could be prescribed the medication during the natural course of care. Main Outcomes and Measures:The primary outcome was initiation of an SGLT2 inhibitor, determined by prescription fill, at any point during the study. The secondary outcome was SGLT2 inhibitor prescription fill at 12 months. The exploratory outcomes, assessed by win ratio analysis, included a composite of time to all-cause mortality, kidney failure, heart failure, myocardial infarction, and stroke along with each of these outcomes individually. Longer time to event for the intervention than the control group was considered a win. Results:Of 8658 eligible patients (mean [SD] age, 78.7 [8.1] years; 8368 [96.7%] male; 76 [0.9%] American Indian or Alaska Native, 11 [0.1%] Asian, 327 [3.8%] Black, 44 [0.5%] Pacific Islander, 7435 [85.9%] White, and 765 [8.8%] with unknown or unreported race), 4400 (50.8%) were assigned to the pharmacist intervention and 4258 (49.2%) to usual care. The cumulative proportion of SGLT2 inhibitor prescriptions filled 1 year after group assignment was 1476 (33.5%) for the intervention group compared with 659 (15.5%) for control. At 12 months, 864 intervention patients (19.6%) filled a prescription for an SGLT2 inhibitor compared with 415 (9.7%) in the control group. The hazard ratio for initiation of an SGLT2 inhibitor in the intervention vs control group was 1.91 (95% CI, 1.69-2.16; P < .001). No significant difference was observed in the composite clinical outcome (win ratio, 1.02; 95% CI, 0.97-1.07; P = .54). Conclusions and Relevance:In this quality improvement study, pharmacist-led outreach was associated with increased initiation of SGLT2 inhibitors; however, limited intervention reach may have constrained the overall impact. Strategies to improve uptake are needed to enhance impact and inform broader SGLT2 inhibitor implementation in patients with CKD and type 2 diabetes.

In today's world the internet has undoubtedly transformed the world into a small village with nearly 66% of its population having access to the world wide web Metin girmek için buraya tıklayın veya dokunun..1 In the past few years, social media platforms have assumed an important role, representing a major reason for which the global population seeks and maintains internet access. Indeed, with an average daily usage of 151 minutes per day in 2022 and 147 min per day in 2021, social media has had a deep impact on people-to-people communication.

We have developed an online calculator to enable clinicians and researchers to calculate the risk for outpatient acute kidney injury based on our recently published model.1 The online calculator may be found at outpatientakirisk.umn.edu. This website allows users to enter required and optional data for a given patient or research participant and provides an estimated risk for outpatient acute kidney injury.

Using vaccine data combined with electronic health records, we report that mRNA boosters provide greater protection than a 2-dose regimen against SARS-CoV-2 infection and related hospitalizations. The benefit of a booster was more evident in the elderly and those with comorbidities.

Background:Trends in the prevalence of chronic kidney disease (CKD) are important for health care policy and planning.Objective:To update trends in CKD prevalence.Design:Repeated cross-sectional study.Setting:NHANES (National Health and Nutrition Examination Survey) for 1988 to 1994 and every 2 years from 1999 to 2012.Participants:Adults aged 20 years or older.Measurements:Chronic kidney disease (stages 3 and 4) was defined as an estimated glomerular filtration rate (eGFR) of 15 to 59 mL/min/1.73 m2, estimated with the Chronic Kidney Disease Epidemiology Collaboration equation from calibrated serum creatinine measurements. An expanded definition of CKD also included persons with an eGFR of at least 60 mL/min/1.73 m2 and a 1-time urine albumin-creatinine ratio of at least 30 mg/g.Results:The unadjusted prevalence of stage 3 and 4 CKD increased from the late 1990s to the early 2000s. Since 2003 to 2004, however, the overall prevalence has largely stabilized (for example, 6.9% prevalence in 2003 to 2004 and in 2011 to 2012). There was little difference in adjusted prevalence of stage 3 and 4 CKD overall in 2003 to 2004 versus 2011 to 2012 after age, sex, race/ethnicity, and diabetes mellitus status were controlled for (P = 0.26). Lack of increase in CKD prevalence since the early 2000s was observed in most subgroups and with an expanded definition of CKD that included persons with higher eGFRs and albuminuria.Limitation:Serum creatinine and albuminuria were measured only once in each person.Conclusion:In a reversal of prior trends, there has been no appreciable increase in the prevalence of stage 3 and 4 CKD in the U.S. population overall during the most recent decade.Primary Funding Source:American Society of Nephrology Foundation for Kidney Research Student Scholar Grant Program, Centers for Disease Control and Prevention, and National Institutes of Health.