Abstract
Diabetic kidney disease (DKD) is the most frequent cause of kidney failure, accounting for half of all cases worldwide. Moreover, deaths from DKD increased 106% between 1990 and 2013 with most attributed to cardiovascular disease. Recommended screening and monitoring for DKD is conducted in less than half of patients with diabetes. Standard-of-care treatment with an angiotensin converting enzyme inhibitor or an angiotensin receptor blocker is correspondingly low. Sodium-glucose cotransporter 2 inhibitors, glucagon-like peptide-1 receptor agonists, and a non-steroidal mineralocorticoid antagonist are highly effective therapies to reduce kidney and cardiovascular risks in DKD. However, fewer than 20% of eligible patients are receiving these agents. Critical barriers are high out-of-pocket drug costs and low reimbursement rates. Data demonstrating clinical and cost effectiveness of DKD care are needed to garner payer and healthcare system support. The pharmaceutical industry should collaborate on value-based care by increasing access through affordable drug prices. Additionally, multidisciplinary models and communication technologies tailored to individual healthcare systems are needed to support optimal DKD care. Community outreach efforts are also central to make care accessible and equitable. Finally, it is imperative that patient preferences and priorities shape implementation strategies. Access to care and implementation of breakthrough therapies for DKD can save millions of lives by preventing kidney failure, cardiovascular events, and premature death. Coalitions comprised of patients, families and community groups, healthcare professionals, healthcare systems, federal agencies and payers are essential to develop collaborative models that successfully address this major public health challenge.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 1092-1103 |
| Number of pages | 12 |
| Journal | Clinical Journal of the American Society of Nephrology |
| Volume | 17 |
| Issue number | 7 |
| DOIs | |
| State | Published - Jul 2022 |
Bibliographical note
Funding Information:S.E. Quaggin reports consultancy agreements with Lowy Medical Research Foundation, AstraZeneca, Boehringer-Ingelheim, Janssen, Roche, Genentech, Novartis, Pfizer, Johnson and Johnson, and UNITY; ownership interest in Mannin Research; serving in an advisory or leadership role for Lowy Medical Research Institute, Mannin, AstraZeneca, JCI, Genentech/Roche, Novartis, Karolinska CVRM Institute, Pfizer, Pfizer ASPIRE program committee, and UNITY; and other interests or relationships as CSO and founder of Mannin Research. W. St. Peter reports consultancy agreements with Total Renal Care, Inc.; honoraria from American Nephrology Nursing Association, OptumLabs, Integritas Group, Letters and Sciences; serving as a Scientific Advisory Board Member for National Kidney Foundation; and other interests or relationships with Centers for Medicare and Medicaid Services Technical Expert Panel on Development of a Quality Measure Assessing Delay in Progression of Chronic Kidney Disease (CKD), NKF and ASN Task Force on eGFR and Race, and Technical Expert Panel for Quality Insights Kidney Care Pilot project. K.R. Tuttle reports consultancy agreements with Boehringer Ingelheim, Novo Nordisk, Bayer, Travere, Janssen, AstraZeneca, and Goldfinch Bio; research funding from Goldfinch Bio, Bayer, and Travere; and honoraria from Gilead, Bayer, Novo Nordisk, and Boehringer Ingelheim. K.R. Tuttle reports relationships with Eli Lilly, Boehringer Ingelheim, Gilead, Astra Zeneca, Goldfinch Bio, Novo Nordisk, Bayer, and Travere for research and other support regarding diabetes and CKD. L. Wong reports employment with DaVita, Inc.; consultancy agreements with Fresenius Medical Therapies; ownership interest in DaVita, Inc.; honoraria from Fresenius Medical Therapies; and serving in an advisory or leadership role for Nephrologists Transforming Dialysis Safety Board of Directors and BMC Nephrology Editorial Board; and serving as a Member at Large on the ASN Excellence in Patient Care Committee.
Funding Information:
K.R. Tuttle reports consultancy agreements with Boehringer Ingelheim, Novo Nordisk, Bayer, Travere, Janssen, AstraZeneca, and Goldfinch Bio; research funding from Goldfinch Bio, Bayer, and Travere; and honoraria from Gilead, Bayer, Novo Nordisk, and Boehringer Ingelheim. K.R. Tuttle reports relationships with Eli Lilly, Boehringer Ingelheim, Gilead, Astra Zeneca, Goldfinch Bio, Novo Nordisk, Bayer, and Travere for research and other support regarding diabetes and CKD.
Publisher Copyright:
© 2022, American Society of Nephrology. All rights reserved.
Keywords
- ACE inhibitors
- Angiotensin receptor blockers
- GLP-1 receptor agonists
- SGLT2 inhibitors
- albuminuria
- cardiovascular disease
- diabetic nephropathy
- non-steroidal mineralocorticoid antagonist
PubMed: MeSH publication types
- Journal Article
