Evidence mapPaperPMID 42317577Full record

ArticleGlomerular diseases

Nudging Nephrologists in Cardiovascular Risk Assessment and Management in Glomerular Diseases Treated with Immunosuppressants: An Implementation Study.

Jovan Sao Ang Sim, Felicia Loo, Lydia Lim, Sing Yi Chia, Regina Lek, Hui Zhuan Tan, Irene Yanjia Mok, Tung Lin Lee, Jason C J Choo, Chieh Suai Tan and 1 more

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Article in Glomerular diseases. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

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5 · Who and what money

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11 authors.

Jovan Sao Ang SimNanyang Technological University, Singapore, Singapore.
Felicia LooDepartment of Renal Medicine, Singapore General Hospital, Singapore, Singapore.
Lydia LimDepartment of Renal Medicine, Singapore General Hospital, Singapore, Singapore.
Sing Yi ChiaHealth Service Research Unit, Singapore General Hospital, Singapore, Singapore.
Regina LekHealth Service Research Unit, Singapore General Hospital, Singapore, Singapore.
Hui Zhuan TanDepartment of Renal Medicine, Singapore General Hospital, Singapore, Singapore.
Irene Yanjia MokDepartment of Renal Medicine, Singapore General Hospital, Singapore, Singapore.
Tung Lin LeeDepartment of Renal Medicine, Singapore General Hospital, Singapore, Singapore.
Jason C J ChooDepartment of Renal Medicine, Singapore General Hospital, Singapore, Singapore.
Chieh Suai TanDepartment of Renal Medicine, Singapore General Hospital, Singapore, Singapore.
Cynthia LimDepartment of Renal Medicine, Singapore General Hospital, Singapore, Singapore.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

Introduction: Glomerulonephritis and its treatment may be associated with cardiometabolic disease, so optimizing glycaemic and lipid control is important to mitigate cardiovascular risk. We aimed to evaluate the impact of an electronic medical record (EMR)-based physician prompt on glycaemic and lipid management among older adults with glomerulonephritis receiving immunosuppressive therapy. Methods: This was a single-centre implementation study with a pre-post-design. We included adults ≥40 years old with active glomerulonephritis treated with immunosuppressants who received the physician prompt between July 2022 and June 2024. Data at 6-monthly intervals were obtained from the EMR. We compared the prevalence of glycaemic and lipid evaluation during follow-up visits before and after the intervention using mixed-effects logistic regression models. Results: A total of 192 patients (median age 58 [interquartile range: 48, 69] years) with 859 visits were included: 474 visits prior to the intervention and 385 visits after its implementation. The most frequent causes of glomerulonephritis were lupus nephritis (26.9%), IgA nephropathy (20.4%), and ANCA-associated vasculitis (15.7%). Glycaemic evaluation was performed at 51.7% and 69.6% of follow-up visits before and after intervention, respectively. Glycaemic evaluation was significantly more likely at post- compared with pre-intervention visits (OR = 2.42 [95% CI: 1.73, 3.36]) after accounting for patients and physicians as random effects, and after adjusting for age, sex, kidney function, follow-up clinic type and duration, and RAS blocker and statin therapy: OR = 2.38 (95% CI: 1.69, 3.38). Fasting lipid was performed at 43.7% and 42.9% of follow-up visits before and after intervention, respectively, and was not different pre- and post-intervention. Conclusion: A physician-directed nudge significantly increased glycaemic evaluation but not lipid evaluation in older patients with glomerulonephritis treated with immunosuppressants.

Indexed as

Cardiovascular diseaseDiabetesGlomerulonephritisKidney failureNudge

Identifiers

PMID42317577
PMCPMC13275059

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