Actively Recruiting
Community Pharmacist Prescription for Diabetic Kidney Disease (Rx4DKD): A Randomized Controlled Trial and Implementation Study
Led by Nova Scotia Health Authority · Updated on 2026-03-18
120
Participants Needed
1
Research Sites
26 weeks
Total Duration
On this page
AI-Summary
What this Trial Is About
Type 2 diabetes is a leading cause of chronic kidney disease, which can lead to serious health problems like kidney failure and heart disease. Despite effective medications existing to slow kidney damage, they are often underused, especially among people without a regular family doctor. To improve care for these individuals, 46 community pharmacy-led primary care clinics were set up in Nova Scotia in 2023. Pharmacists at these clinics can prescribe for chronic conditions but currently not for diabetic kidney disease. This research evaluates whether pharmacist-led prescribing algorithms can improve the use of kidney-protective medications in people with diabetic kidney disease who lack regular primary care. The study compares two groups of adults with type 2 diabetes and diabetic kidney disease who do not have a primary care provider. One group receives pharmacist-led care using validated prescribing algorithms integrated into a digital health app, supporting medication management for diabetic kidney disease. The other group receives usual care through walk-in, mobile, or virtual clinics. Participants are randomly assigned to one of these groups and followed for 12 months. Pharmacists will also complete surveys to identify what helps or hinders using these algorithms in real-world practice. Participants will be recruited from a diabetes registry and screened at pharmacy clinics to confirm diabetic kidney disease. They will have lab tests and follow-up visits as part of the study. Researchers will monitor how many start and continue recommended kidney-protective medications, any medication side effects, hospitalizations, and barriers to implementation. The main outcome is improved use of guideline-directed medical therapy over 12 months. The study aims to expand access to effective treatments for diabetic kidney disease and improve long-term health outcomes in underserved populations.
CONDITIONS
Brief Title
Improving Kidney Care in Type 2 Diabetes: A Study of Pharmacist Prescribing Versus Usual Care
Who Can Participate
Eligibility Criteria
You may qualify if you...
- Adults 18 years or older with type 2 diabetes and diabetic kidney disease (eGFR between 30 and 60 ml/min/1.73m2 and/or UACR 3 mg/mmol or higher)
- Adults without a regular primary care provider
- Adults eligible to start treatment with renin-angiotensin system inhibitors, SGLT2 inhibitors, or nonsteroidal mineralocorticoid receptor antagonists
You will not qualify if you...
- Low blood pressure (hypotension)
- Type 1 diabetes
- History of allergy or intolerance to renin-angiotensin system inhibitors, SGLT2 inhibitors, or nonsteroidal mineralocorticoid receptor antagonists
- Already receiving all three medications: renin-angiotensin system inhibitors, SGLT2 inhibitors, and nonsteroidal mineralocorticoid receptor antagonists
- Potassium levels or kidney function below safe algorithm thresholds (eGFR less than 30 ml/min/1.73m2)
- Life expectancy less than 1 year
- Being followed by a kidney specialist or endocrinologist
- Unable to give consent
AI-Screening
AI-Powered Screening
Complete this quick 3-step screening to check your eligibility
Your Study Journey
Duration - 2 to 4 weeks
Participants are screened for eligibility to participate in the trial.
1 screening and enrollment visit (in-person at pharmacy clinic)
Duration - 12 months
Participants are randomized to receive either pharmacist-led diabetic kidney disease management using validated prescribing algorithms at community pharmacy clinics or usual care through walk-in, mobile, or virtual clinics.
Ongoing visits as needed at community pharmacy clinics or usual care locations
Trial Site Locations
Total: 1 location
1
Dalhousie University
Halifax, Nova Scotia, Canada, b3h 2y9
Actively Recruiting
Research Team
J
Jo-Anne Wilson, BSc Pharm, ACPR, MEd, PharmD
L
Laura Sills, RN, BSN
How is the study designed?
Study Type
INTERVENTIONAL
Masking
NONE
Allocation
RANDOMIZED
Model
PARALLEL
Primary Purpose
HEALTH_SERVICES_RESEARCH
Number of Arms
2
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