NUDGE-CKD and the Power of Pragmatic Trials

In this episode of Kidney Compass, host Brendon Neuen, MBBS, PhD, is joined by Tor Biering-Sørensen, MD, MPH, PhD, and Kristoffer Skaarup, MD, to discuss the design, execution, and implications of the NUDGE-CKD trial—a landmark pragmatic study aimed at improving guideline-based care in chronic kidney disease (CKD). NUDGE-CKD tested whether low-cost digital “nudges”—letters sent to patients and their primary care physicians emphasizing evidence-based CKD therapies—could increase use of guideline-directed medical therapies (GDMT) for people with CKD. Using Denmark’s nationwide registries and E-box digital communication system, the team identified > 160,000 individuals with CKD and ultimately randomized nearly 20,000 patients into different trial arms. Key findings showed a modest but meaningful increase in GDMT uptake among patients who received the nudges—particularly when both patients and GPs received communication. While the patient-only letters had little effect, the combined approach led to greater prescribing of key medications and improved risk factor control.