CKD Therapy Unchanged by Patient and PCP Nudge Letters
METHODOLOGY:
NUDGE-CKD included all Danish individuals aged 18 years or older on August 19, 2024, who had received a diagnosis of CKD in the previous 5 years during at least one hospital encounter and who were enrolled in the Danish governmental electronic letter system, which has 95% coverage. It also included all Danish general practices contactable via electronic letter that had at least one patient with CKD on their list.
For patients, the letter highlighted the potential benefits of kidney and heart health and encouraged a discussion of treatment options, while for general practitioners, the letter focused on the latest treatment guidelines.
In the patient arm of the study, 22,627 individuals were randomly assigned to receive a letter (n = 11,223) or no letter (n = 11,394). The average age was 71 years, and approximately 36% were women.
For the practitioner arm, 1540 general practices, caring for 28,069 patients with CKD, were assigned to receive a letter (774 practices caring for 13,959 patients) or usual care (766 practices caring for 14,110 patients). The average patient age was 73 years, and approximately 39% were women.
Both patients and practices were followed up for 6 months (until February 19, 2025), with the primary endpoint the number of filled prescriptions for a renin-angiotensin system inhibitor (RASi) or SGLT2 inhibitor (SGLT2i).
TAKEAWAY:
The patient analysis revealed that there was no significant difference in prescriptions of RASi or SGLT2i between those who received a nudge letter and those who did not, at a relative risk of 0.99 ( P = .21).
= .21). Very similar results were seen on the general practice analysis, at a relative risk of a RASi or SGLT2i prescription with a nudge letter vs usual care of 0.99 ( P = .41).
= .41). No significant differences were seen on the subgroup analysis and when looking at the time to prescription for new users, and there was no interaction between the patient and general practice results ( P = .85).
IN PRACTICE:
The trial was the 'largest provider-targeted implementation study to date evaluating a scalable, low-cost strategy to improve the use of guideline-related medical therapy in CKD' and the 'first large-scale trial of a digitally delivered strategy targeting patients with a common chronic condition,' said the study presenter.
'While the results were neutral, they may provide valuable insights for future efforts,' he concluded.
SOURCE:
The research was conducted by Kristoffer Grundtvig Skaarup, MD, Department of Cardiology, Copenhagen University Hospital — Herlev and Gentofte, Denmark, and colleagues, and described over two presentations at the 62nd European Renal Association (ERA) Congress 2025 on June 7.
LIMITATIONS:
Skaarup pointed out that, on the general practice side, the intervention was a 'one-time letter…and not linked to specific patients, which may have limited its lasting impact.' He suggested that more integrated approaches timed to clinical encounters or even embedded into existing clinical workflows closer to when prescription decisions are made may be more effective in primary care.
Although most patients reported reading the letter, Skaarup said that few acted on it, potentially due to its general, non-personalized content, with no explicit medical therapy recommendations, which may limit its perceived relevance or urgency.
DISCLOSURES:
No external funding was obtained for the trial. Skaarup received funding through a research grant from the Danish Cardiovascular Academy, which is supported by the Novo Nordisk Foundation and the Danish Heart Foundation.
No relevant financial relationships were declared.
Liam Andrew Davenport, MA (Hons), is a UK-based medical journalist and writer with more than 20 years' experience. He studied medical sciences and anthropology at Emmanuel College, Cambridge, England.
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