Abstract Body (Do not enter title and authors here): Introduction:
Chronic kidney disease (CKD) is a global health concern, particularly among patients with type 2 diabetes mellitus (T2DM) and prediabetes, who are at high risk of cardiovascular disease (CVD). The Center for Integrated and Novel Approaches in Vascular-Metabolic Disease (CINEMA) program at University Hospitals Cleveland Medical Center aims to address these challenges through a multidisciplinary, patient-centered intervention. This study evaluates CKD prevalence, outcomes, and guideline-directed treatments within the CINEMA program.

Methods:
Patients with T2DM or prediabetes at high-risk for cardiovascular events, including those with established atherosclerotic CVD, elevated coronary artery calcium score ≥100, chronic heart failure, ischemic stroke, peripheral arterial disease, CKD (defined as eGFR<60mL/min/1.73m² and/or by the presence of albuminuria, UACR ≥30 mg/g) and obesity with metabolic syndrome were included.

Results:
From May 2020 to September 2022, 454 patients were enrolled in the CINEMA program with 45% having a diagnosis of CKD. Among those with CKD, the median age was 64 years, 48% were women, and 47% were Black. 93% had T2DM, 82% had HTN, 52% had established coronary artery disease, and 39% had heart failure. Median eGFR was 49 mL/min/1.73m² and median UACR was 42 mg/g. Over two-thirds of those with CKD were stage G3 or greater and 50% were stage A2 or greater. Persons with CKD were more likely to be older, Black, have diabetes and heart failure (p<0.05 for all). UACR screening increased ~8-fold with the CINEMA program. The CINEMA intervention was associated with statistically significant improvements in cardiometabolic risk factors with reductions in body weight (-3.49 lbs), BMI (-0.54 kg/m2), systolic blood pressure (-2.65 mmHg), Hb A1c (-0.63%), total cholesterol (-9.01 mg/dL) and LDL cholesterol (-8.29 mg/dL) with p<0.05 for all. No significant changes were seen in eGFR (p=0.58) or UACR (p=0.41). Notably, there was significant increase in prescription rates of SGLT2i (25% to 55%) and GLP-1RA (14% to 38%) in the CKD population from baseline to follow-up visit (p<0.05).

Conclusions:
The CINEMA program demonstrates effectiveness in improving ASCVD risk factors and shows promise in addressing CKD outcomes among high-risk patients with T2DM or prediabetes. Enhanced screening for CKD, proper risk stratification, and aggressive implementation of guideline directed medical therapies in patients with CKD can lead to improved outcomes.