慢性腎臓病および第2型糖尿病患者におけるガイドライン指向医療の最適化

Rosalba Santana¹, Chinweizu Deborah Umana¹, Zin Thawdar Oo¹

¹Department of Medicine, North Central Bronx Hospital, Bronx, NY.

|September 3, 2025

まとめ

慢性腎臓病と2型糖尿病に対するレニン・アニオテンシン・アルドステロン系阻害剤 (RAASi) とナトリウム・グルコース・コトランスポーター-2阻害剤 (SGLT2i) の処方を改善した. このアプローチは格差を拡大することなく公平なケアを提供することを促進しました

科学分野:

腎臓科
内分泌学
臨床薬局

背景:

KDIGOのガイドラインでは,CKDとT2DMのRAASiとSGLT2iが推奨されていますが,実装のギャップがあります.
これらの重要な薬を処方する障壁は患者の最適なケアを妨げます
これらの障壁を特定し対処することは治療結果の改善に不可欠です

研究の目的:

RAASiとSGLT2iをCKDとT2DMの患者に処方するための障壁を特定する.
これらの障壁を克服するための標的型戦略を策定し,実施する.
薬の処方率と健康の公平性に対する介入の影響を評価する.

主な方法:

RAASiとSGLT2iの処方パターンの遡及的分析
処方障害に関するプライマリケア提供者の調査
教育的な介入の実施
処置後の処方率の再評価

主要な成果:

ハイパーカリミアと低GFRは,RAASiの開始/継続における主要な障害であった.
保険と不耐性により SGLT2iの使用が制限されています.
UACRスクリーニングにより,RAASiとSGLT2iの処方値が増加した (P=0. 03,P=0. 019).
教育的な介入により,SGLT2i (95%) とRAASi (4%) の割合は均等に上昇した.

結論:

ターゲットを絞った教育介入は証拠に基づいた処方箋を効果的に改善します
介護の提供は人口の多様性によって平等に改善できます
将来の研究は,AI主導の戦略と成果に基づく研究に焦点を当てるべきです.

キーワード:

SGLT2阻害剤アンジオテンシン変換酵素阻害剤アンジオテンシン受容体阻害剤慢性腎臓疾患糖尿病糖尿病ガイドラインによる医療療法

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