{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,4]],"date-time":"2026-05-04T01:43:25Z","timestamp":1777859005163,"version":"3.51.4"},"reference-count":34,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2025,7,1]],"date-time":"2025-07-01T00:00:00Z","timestamp":1751328000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2025,7,1]],"date-time":"2025-07-01T00:00:00Z","timestamp":1751328000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["J Prim Care Community Health"],"published-print":{"date-parts":[[2025,7]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Chronic kidney disease (CKD) management was largely centered around renin-angiotensin-aldosterone system inhibitors (RAASi) optimization, until recent emergence of novel therapeutics. However, slow adoption of guideline-directed therapy leaves patients vulnerable to disease progression. In 2022, a data-driven informatics approach was introduced to track real-time adherence to best practices.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>This multi-center, ambidirectional cohort study analyzed data from a shared electronic health record system in a public healthcare cluster in Singapore, comprising 7 primary care institutions and 3 tertiary care hospitals. Patients aged \u226521 with CKD, managed between 1st March 2022 and 31st March 2024, were included. Prescription trends for RAASi, sodium-glucose co-transporter-2 inhibitors (SGLT2i), non-steroidal mineraloreceptor antagonists, and statins were examined, alongside albuminuria monitoring and comprehensive care uptake.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>Among 34\u2009217 patients, mean age was 72\u2009\u00b1\u200912\u2009years; 57% received RAASi, 21% SGLT2i, and 66% statins. Among those meeting therapeutic indications, RAASi uptake remained stable at 74%, with 40% receiving ceiling doses. SGLT2i uptake doubled but remained below 40%, with lower adoption in non-diabetic and non-obese patients. Only 21% of albuminuric CKD G1-3b patients received optimal combination therapy with RAASi, SGLT2i, and statins despite only 4% hyperkalemia prevalence and 2% with systolic BP &lt;110\u2009mmHg. Among albuminuric CKD G3 patients with 5-year end-stage kidney disease risk \u226515%, 28% received optimal therapy. One-third lacked albuminuria monitoring and were less likely to receive comprehensive therapy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>Gaps persist in CKD care, particularly among non-diabetic, non-obese patients, and those without albuminuria monitoring. Health informatics-driven interventions can facilitate real-time process evaluation and adherence to best practices amid evolving treatment landscapes.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/21501319251365314","type":"journal-article","created":{"date-parts":[[2025,9,8]],"date-time":"2025-09-08T08:11:47Z","timestamp":1757319107000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Multi-Center Health Informatics to Examine the Implementation of Guideline-Directed Medical Therapy in Chronic Kidney Disease"],"prefix":"10.1177","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2047-4444","authenticated-orcid":false,"given":"Yan Ting","family":"Chua","sequence":"first","affiliation":[{"name":"Division of Nephrology, Department of Medicine, National University Hospital, Singapore"},{"name":"Yong Loo Lin School of Medicine, National University of Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Horng-Ruey","family":"Chua","sequence":"additional","affiliation":[{"name":"Division of Nephrology, Department of Medicine, National University Hospital, Singapore"},{"name":"Yong Loo Lin School of Medicine, National University of Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Priyanka","family":"Khatri","sequence":"additional","affiliation":[{"name":"Yong Loo Lin School of Medicine, National University of Singapore"},{"name":"Fast and Chronic Programmes, Department of Medicine, Alexandra Hospital, Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shilpa","family":"Rastogi","sequence":"additional","affiliation":[{"name":"Division of Renal Medicine, Department of Medicine, Ng Teng Fong General Hospital, Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sky Wei Chee","family":"Koh","sequence":"additional","affiliation":[{"name":"Yong Loo Lin School of Medicine, National University of Singapore"},{"name":"National University Polyclinics, Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Valerie","family":"Ma","sequence":"additional","affiliation":[{"name":"Division of Nephrology, Department of Medicine, National University Hospital, Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Clara Lee Ying","family":"Ngoh","sequence":"additional","affiliation":[{"name":"Division of Nephrology, Department of Medicine, National University Hospital, Singapore"},{"name":"Yong Loo Lin School of Medicine, National University of Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2025,9,8]]},"reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa011161"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa011303"},{"key":"e_1_3_2_4_2","volume-title":"2022 USRDS Annual Data Report: Epidemiology of kidney disease in the United States","author":"United States Renal Data System","year":"2022","unstructured":"United States Renal Data System. 2022 USRDS Annual Data Report: Epidemiology of kidney disease in the United States. 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