How Lab-Based Risk Flags Help Overcome Clinical Inertia in CKD

Navdeep Tangri, MD, PhD, FRCP, explains how flagging roughly 3 in 10 patients as high risk prompted physicians to increase use of guideline-directed therapy. In an interview with Pharmacy Times for Kidney Week 2026, Navdeep Tangri, MD, PhD, FRCP, professor of medicine at the University of Manitoba in Canada, discussed findings from an abstract on albuminuria testing and guideline-directed medical therapy (GDMT) in chronic kidney disease (CKD).

The abstract tested 2 quality improvement strategies: flagging high-risk patients in the medical record and giving physicians quarterly audits and feedback. 1 Tangri said physicians want to provide optimal care, but the routine of a busy practice and clinical inertia often get in the way.

His team used laboratory data already in the medical record to identify, with high accuracy, the patients at greatest risk of disease progression, roughly 3 in 10 patients. Physicians then saw a flag on those patients' records, which let them budget their time and resources and, in effect, pre-round before entering the room.

Tangri emphasized that the approach works because it is selective: if every patient is labeled high risk, then nobody is. Combined with the knowledge that progression risk can be modified with highly effective therapy, the flags led physicians to increase their use of GDMT. 1 Tangri described audit and feedback as one of the best-known ways to improve quality of care across clinicians and settings.

Physicians were benchmarked on their urine albumin-to-creatinine ratio (UACR) testing rates against peers in their local clinic, their region, and the practice overall, which included more than 180 physicians. Over time, he said, competition helped everybody rise to the top. Nearly all physicians improved their UACR testing, and he estimated that 80% to 90% also increased their appropriate use of guideline-directed therapy.

For pharmacists, the findings show how data already available in the medical record can identify the patients who stand to benefit most from GDMT and how routine feedback can sustain improvements in both testing and prescribing. Tangri characterized the feedback component simply as introducing some friendly competition.

REFERENCE 1. Tangri N, Ferguson TW, Bhanushali GK, et al. Applying risk stratification to improve guideline-directed medical therapy uptake and albuminuria testing in a large US nephrology practice; Abstract FR-PO0018.

Presented: American Society of Nephrology Kidney Week; Denver, CO; October 23, 2026. Accessed online November 9, 2026. https://www.asn-online.org/education/kidneyweek/2026/program-abstract.aspx?controlId=4559215 Related to this article