Pharmacist prescribing to improve kidney care for people with type 2 diabetes

Community Pharmacist Prescription for Diabetic Kidney Disease (Rx4DKD): A Randomized Controlled Trial and Implementation Study

This project will test whether pharmacist prescribing guided by step-by-step algorithms helps adults with type 2 diabetes and early diabetic kidney disease who lack a regular doctor start recommended kidney‑protecting medications.

Quick facts

• Phase: NA
• Study type: Interventional
• Enrollment: 120 (estimated)
• Ages: 18 Years and up
• Sex: All
• Sponsor: Nova Scotia Health Authority (other)
• Locations: 1 site (Halifax, Nova Scotia)
• Trial ID: NCT07169422 on ClinicalTrials.gov

What this trial studies

This is a hybrid type 1 effectiveness-implementation pilot randomized controlled trial comparing pharmacist-led prescribing using validated diabetic kidney disease algorithms integrated into a digital health app versus usual care delivered by walk-in, mobile, or virtual clinics. The intervention will be delivered through community pharmacist-led primary care clinics launched across Nova Scotia, where pharmacists can prescribe for chronic conditions. The primary focus is on improving uptake of guideline-directed medical treatments (RAS inhibitors, SGLT2 inhibitors, and nsMRA) among adults with earlier-stage diabetic kidney disease who do not have a primary care provider. Feasibility metrics (implementation and recruitment) and medication initiation rates will be measured to inform larger scale implementation.

Who should consider this trial

Good fit: Adults (≥18) with type 2 diabetes and diabetic kidney disease (eGFR 30–60 mL/min/1.73m2 and/or UACR ≥3 mg/mmol) who do not have a primary care provider and are eligible to start a RAS inhibitor, SGLT2 inhibitor, or nsMRA are ideal candidates.

Not a fit: People with type 1 diabetes, eGFR <30 mL/min/1.73m2, contraindications or allergies to the study medications, already receiving all three target medications, under subspecialty care, with life expectancy <1 year, or unable to consent are unlikely to benefit from this intervention.

Why it matters

Potential benefit: If successful, more people with type 2 diabetes and early diabetic kidney disease—especially those without a regular doctor—could start guideline-recommended kidney‑protecting medicines sooner, potentially slowing kidney decline and reducing cardiovascular risk.

How similar studies have performed: Pharmacist-led medication management has improved chronic disease care in other settings, but algorithm-guided pharmacist prescribing specifically for diabetic kidney disease is relatively novel and not widely tested.

Eligibility criteria

Inclusion Criteria:

* Adults ≥18 years with T2D and DKD (eGFR≥ 30-60 ml/min/1.73m2 and/or UACR≥3 mg/mmol)
* Adults who do not have primary care provider,
* Adults who are eligible for initiation of treatment with RASi, SGLT2i or nsMRA

Exclusion Criteria:

* Hypotension
* Type 1 diabetes
* History of allergy or intolerance to either, renin angiotensin system inhibitor (RASi), SGLT2 inhibitor (SGLT2i) and nonsteroidal mineralocorticoid receptor antagonist (nsMRA).
* Already receiving all three medications: RASi, SGLT2i, and nsMRA .
* Exceed algorithm thresholds for potassium levels or eGFR less than 30 mL/min/1.73m²
* Limited life expectancy of less than 1 year
* Followed by a subspecialty physician (e.g., nephrologist or endocrinologist)
* Unable to give consent

Where this trial is running

Halifax, Nova Scotia

• Dalhousie University — Halifax, Nova Scotia, Canada (RECRUITING)

Study contacts

• Study coordinator: Jo-Anne Wilson, BSc Pharm, ACPR, MEd, PharmD

Conditions: Diabetic Kidney Disease, Type 2 Diabetes, Chronic Kidney Disease, diabetic kidney disease, pharmacist-led prescribing, type 2 diabetes, guideline directed medical treatments, pharmacy care models