Diabetic kidney disease is the most frequent cause of kidney failure, accounting for half of all cases worldwide. Moreover, deaths from diabetic kidney disease increased 106% between 1990 and 2013, with most attributed to cardiovascular disease. Recommended screening and monitoring for diabetic kidney disease are 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 nonsteroidal mineralocorticoid antagonist are highly effective therapies to reduce kidney and cardiovascular risks in diabetic kidney disease. However, <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 diabetic kidney disease care are needed to garner payer and health care 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 health care systems are needed to support optimal diabetic kidney disease 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 diabetic kidney disease can save millions of lives by preventing kidney failure, cardiovascular events, and premature death. Coalitions composed of patients, families, community groups, health care professionals, health care systems, federal agencies, and payers are essential to develop collaborative models that successfully address this major public health challenge.
|Original language||English (US)|
|Number of pages||12|
|Journal||Clinical Journal of the American Society of Nephrology|
|State||Published - Jul 2022|
Bibliographical noteFunding 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.
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.
© 2022, American Society of Nephrology. All rights reserved.
- ACE inhibitors
- Angiotensin receptor blockers
- cardiovascular disease
- diabetic nephropathy
- GLP-1 receptor agonists
- non-steroidal mineralocorticoid antagonist
- SGLT2 inhibitors
- Angiotensin-Converting Enzyme Inhibitors/therapeutic use
- Mineralocorticoid Receptor Antagonists/therapeutic use
- Diabetes Mellitus, Type 2/drug therapy
- Renal Insufficiency
- Diabetic Nephropathies/diagnosis
- Angiotensin Receptor Antagonists/therapeutic use
PubMed: MeSH publication types
- Journal Article