PrescQIPP

Cardiorenal Optimisation (2025)

Aneurin Bevan University Health Board

Project summary

In June 2023, I was recruited as the lead clinical pharmacist to start a project with funding provided by the Value-Based Healthcare team, to provide a cardio-renal optimisation service to GP practices. The service focuses on increasing the prescribing of Sodium-Glucose Co-Transporter inhibitors (SGLT2i’s) in patients with T2DM in order to improve the health outcomes for our patients. The project team consists of independent prescribing pharmacists, a pharmacy technician, an administrative assistant and the project was supported by secondary care consultant nephrologist Dr Alexa Wonnacott and diabetologist Dr Mousumi Biswas and the primary care diabetes lead, Dr David-Millar-Jones.
There were a number of reasons why this initiative was needed:

  • 7.6% of our population in Wales has Chronic Kidney Disease (CKD) between stages 3-5 and the number of patients being diagnosed with CKD is increasing.
  • CKD is linked with a high cardiovascular disease burden
  • The number of patients reaching end stage renal disease (ESRD) and requiring renal replacement therapy (RRT) is now greater in Wales than in England. 

T2DM is responsible for 42% of all cases of CKD and this condition is largely managed in primary care.  The project objectives were to identify all those patients in the practice with a diagnosis of T2DM who had CKD or who were at risk of CKD and who would benefit from a SGLT2i being prescribed. 

The aim of the project was to prevent or reduce the progression of CKD, reduce the numbers of patients reaching ESRD and reduce the risk of cardiovascular complications in these patients. We also wanted to make sure that we were carrying out patient centric medication reviews and deprescribe any medicines that did not have any health-related gains associated with them. 

The practices were sent an SOP outlining the project and data was then collected from the clinical system. The pharmacy technician would then screen the patients and look for any contra-indications to prescribing a SGLT2i. The pharmacist would then put in place a proposed optimisation plan and any queries would be discussed with the multi-disciplinary team (MDT). Clinic sessions were arranged with the practice and all eligible patients were sent a letter inviting them to attend a cardiorenal optimisation review. 

Across Newport and Caerphilly localities 30 out of 36 practices have responded and agreed to participate in the project. So far, we have reviewed 1180 patient and optimised 842 patients on a SGLT2i along with a whole host of other optimisation and medication changes. The SGLT2i prescribing rates since June 2023 have increased significantly in patients with T2DM at risk of CKD and we have also made some cost savings in deprescribing gliptins, which do not have any health-related gains associated with them.