Overview of the PRN
The Nephrology PRN unites pharmacists dedicated to kidney care from a wide range of practice settings including ambulatory care, internal medicine, critical care, transplant, academia, and the pharmaceutical industry. Our members represent diverse backgrounds and experience levels, spanning from seasoned nephrology experts to trainees and clinicians newly entering the field.
Established in 1993 with 73 founding members, the PRN has grown to almost 300 members worldwide. Together, we share a common commitment to advancing nephrology pharmacotherapy through excellence in education, clinical practice, research, and engagement with professional nephrology organizations.
The Nephrology PRN strives to advance the scope of nephrology pharmacotherapy through excellence in education, clinical practice, research, and involvement in professional nephrology organizations and to promote optimal patient outcomes in the population with CKD through comprehensive medication management. The PRN invests in the next generation of nephrology pharmacists through travel awards to both residents and students together with leadership and mentorship opportunities.
Opportunities and Resources for PRN Resident, Fellow, and Student Members
This year, the Nephrology PRN proudly supported 1 student and 1 resident member through travel awards to attend the 2025 ACCP Annual Meeting in Minneapolis, Minnesota. Both awardees presented their research during the Nephrology PRN Business Meeting and had the opportunity to connect and collaborate with members across the network.
The PRN continues to provide meaningful engagement opportunities for trainees through virtual networking sessions with practitioners, as well as past webinars and journal clubs featuring nephrology-focused topics. Many of these events have included contributions from resident, fellow, and student members. Trainees are encouraged to join PRN subcommittees, where their enthusiasm and fresh perspectives make a significant impact. Looking ahead, the membership subcommittee plans to reinstate the quarterly NephNews newsletter and welcomes trainee involvement in its content development. Trainees can also be involved in social media member engagement. We look forward to continued collaboration with our resident, fellow, and student members and invite all trainees to participate in and contribute to the PRN’s future initiatives.
Current Clinical Issues
Improving Adherence to Guideline-Directed Medical Therapies in Patients with Type 2 Diabetes and Chronic Kidney Disease
Dr Sky Harrigfeld
PGY2 Ambulatory Care Pharmacy Resident
University of Illinois Hospital & Health Sciences System
The global prevalence of chronic kidney disease (CKD) continues to rise, driven in part by the growing burden of type 2 diabetes (T2D).1 People with diabetes-associated kidney disease (DKD) are at increased risk of cardiovascular disease, morbidity, and mortality.2 Guideline-directed medical therapy (GDMT) for DKD has recently expanded beyond angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers to include sodium-glucose cotransporter-2 inhibitors, glucagon-like peptide-1 receptor agonists, and nonsteroidal mineralocorticoid receptor antagonists.2 Early comprehensive screening and diagnosis through both estimated glomerular filtration rate and urine albumin-to-creatinine ratio and implementation of GDMT are associated with improved kidney and cardiovascular outcomes.3 Despite these benefits, both screening rates for DKD and implementation of GDMT remain suboptimal.4
My ongoing research project, Improving Adherence to Guideline-Directed Medical Therapies in Patients with Type 2 Diabetes and Chronic Kidney Disease, aims to further characterize and address these gaps in care for people with DKD. In this paper, my coauthors and I will first identify current rates of screening and GDMT use among patients with T2D at the University of Illinois Hospital & Health Sciences System. We will then examine patient, provider, and system-level factors that affect DKD screening and GDMT implementation.
To address these gaps in care, we have developed a remote pharmacist-led intervention that aims to improve rates of DKD screening and GDMT prescribing in patients with T2D with and without CKD. After review by a primary care provider, the research team will review clinical notes, laboratory results, and prescription records to assess the success of the intervention.
References
1. Francis A, Harhay MN, Ong ACM, et al. Chronic kidney disease and the global public health agenda: an international consensus. Nat Rev Nephrol. 2024;20(7):473-485. https://doi.org/10.1038/s41581-024-00820-6
2. American Diabetes Association Professional Practice Committee. 11. Chronic kidney disease and risk management: Standards of Care in Diabetes–2025. Diabetes Care. 2025;48(1 suppl 1):S239-S251. https://doi.org/10.2337/dc25-S011
3. Sarafidis P. Use of ACEi/ARBs, SGLT2 inhibitors and MRAs can help us reach the therapeutic ceiling in CKD. Clin Kidney J. 2024;17(2):sfae014. https://doi.org/10.1093/ckj/sfae014
4. Tangri N, Peach EJ, Franzén S, Barone S, Kushner PR. Patient management and clinical outcomes associated with a recorded diagnosis of stage 3 chronic kidney disease: the REVEAL-CKD study. Adv Ther. 2023;40(6):2869-2885. https://doi.org/10.1007/s12325-023-02482-5
Nephrology PRN Focus Session Recap
Andrew Bauman, Pharm.D. Candidate 2026
The University of Findlay, Findlay, OH
At the 2025 ACCP Annual Meeting, the Nephrology PRN hosted a focus session on the 2025 KDIGO Anemia in CKD Guideline draft, highlighting major updates and clinical implications.1 The session opened with a review of the evolving approach to diagnosing and evaluating CKD-related anemia, emphasizing the importance of assessing iron status before pursuing a full anemia workup. Of note, the draft introduces distinct ferritin and transferrin saturation (TSAT) thresholds for initiating iron therapy in patients with CKD stages 1 to 5, including those receiving peritoneal dialysis but not hemodialysis (HD). The updated recommendation advises initiating iron supplementation when ferritin is less than 100 ng/mL with TSAT less than 40%, or when ferritin is 100 to 300 ng/mL with TSAT less than 25% (grade 2D). For patients receiving HD, the thresholds remain the same as before (TSAT 30% or less and ferritin 500 ng/mL or less; grade 2D). Intravenous iron remains preferred for patients receiving HD, whereas either oral or intravenous routes are appropriate for those not receiving HD.
Another key highlight of the session was the discussion on erythropoiesis-stimulating agents (ESAs) and hypoxia-inducible factor–prolyl hydroxylase inhibitors (HIF-PHIs). Presenters reviewed current KDIGO and FDA guidance for ESA initiation and hemoglobin targets to maximize efficacy and minimize major adverse cardiovascular events. The novel mechanism of HIF-PHIs was also reviewed, underscoring how inhibition of HIF–prolyl hydroxylase enzymes stabilizes the HIF, enhancing erythropoietin production, iron absorption, and RBC synthesis. Vadadustat, the newly approved oral HIF-PHI, is approved for anemia in patients with CKD who have received dialysis for at least 3 months because it has shown efficacy similar to darbepoetin alfa with similar cardiovascular outcomes, as evidenced by the INNO2VATE trial.2 However, despite the promise of this new class, the 2025 KDIGO draft continues to recommend ESAs as first-line therapy, reserving HIF-PHIs for patients who are ESA-hyporesponsive. The session concluded with updates on emerging oral and intravenous iron formulations, offering clinicians new tools to optimize anemia management in CKD. Overall, the session offered an engaging and comprehensive review of the highly anticipated KDIGO guidelines, leaving attendees eager for the official publication and the practice-changing insights it promises.
References
1. Kidney Disease: Improving Global Outcomes (KDIGO). KDIGO 2025 clinical practice guideline for the evaluation and management of chronic kidney disease. Draft for public review. November 2024.
2. Macdougall IC, White C, Anker SD, et al; PIVOTAL Investigators and Committees. Intravenous iron in patients undergoing maintenance hemodialysis. N Engl J Med. 2019;380(5):447-458. https://doi.org/10.1056/NEJMoa1810742