Kidney International Reports, Journal Year: 2024, Volume and Issue: 9(6), P. 1541 - 1552
Published: June 1, 2024
Historically, it takes an average of 17 years to move new treatments from clinical evidence daily practice. Given the highly effective now available prevent or delay kidney disease onset and progression, this is far too long. The time narrow gap between what we know do. Clear guidelines exist for prevention management common risk factors disease, such as hypertension diabetes, but only a fraction people with these conditions worldwide are diagnosed, even fewer treated target. Similarly, vast majority living unaware their condition, because in early stages often silent. Even among patients who have been many do not receive appropriate treatment disease. Considering serious consequences failure, death, imperative that initiated appropriately. Opportunities diagnose treat must be maximized beginning at primary care level. Many systematic barriers exist, ranging patient clinician health systems societal factors. To preserve improve everyone everywhere, each acknowledged so sustainable solutions developed implemented without further delay. At least 1 10 disease.1Jager K.J. Kovesdy C. Langham R. et al.A single number advocacy communication-worldwide more than 850 million individuals diseases.Kidney Int. 2019; 96: 1048-1050Abstract Full Text PDF PubMed Google Scholar According Global Burden Disease study, 2019, >3.1 deaths were attributed dysfunction, making seventh leading factor death (Figure Supplementary Figure S1).2Institute Health Metrics Evaluation (IHME)GBD compare data visualization.http://vizhub.healthdata.org/gbd-compareDate accessed: November 18, 2023Google However, global mortality all diseases may actually range 5 11 per year if estimated lives lost, especially lower-resource settings, acute injury lack access replacement therapy failure (KF) also counted.3Luyckx V.A. Tonelli M. Stanifer J.W. burden development goals.Bull World Organ. 2018; 414-422DCrossref Scopus (487) These high rates reflect disparities prevention, detection, diagnosis, chronic (CKD).4International Society NephrologyISN Kidney Atlas.3rd ed. 2023https://www.theisn.org/initiatives/global-kidney-health-atlas/Date Death CKD prominent some regions, particularly Central Latin America Oceania (islands South Pacific Ocean), indicating need urgent action.5GBD Chronic CollaborationGlobal, regional, national 1990-2017: analysis Study 2017.Lancet. 2020; 395: 709-733Abstract (3172) poses significant economic burden, costs increasing exponentially progresses, dialysis transplantation, multiple comorbidities complications accumulate over time.6Vanholder Annemans L. Brown E. al.Reducing while delivering quality care: call action.Nat Rev Nephrol. 2017; 13: 393-409Crossref (207) Scholar,7Nguyen-Thi H.Y. Le-Phuoc T.N. Tri Phat N. al.The Vietnam.Health Serv Insights. 2021; 1411786329211036011Google In United States, Medicare fee-for-service spending beneficiaries was $86.1 billion 2021 (22.6% total expenditure).8US Renal Data SystemHealthcare expenditures persons CKD.https://usrds-adr.niddk.nih.gov/2023/chronic-kidney-disease/6-healthcare-expenditures-for-persons-with-ckdDate settings absent, where most paid out pocket. A recent study Vietnam reported cost higher gross domestic product capita.7Nguyen-Thi Australia, has diagnosis could save system $10.2 20 years.9Kidney AustraliaTransforming Australia's health: action detection disease.https://kidney.org.au/uploads/resources/Changing-the-CKD-landscape-Economic-benefits-of-early-detection-and-treatment.pdfDate January 16, 2024Google Although there regional variation causes CKD, highest population-attributable age-standardized CKD-related disease-adjusted life follows: blood pressure (51.4%), fasting plasma glucose level (30.9%), body mass index (26.5%).10Ke Liang J. Liu al.Burden its risk-attributable 137 low-and middle-income countries, 1990-2019: results 2019.BMC 2022; 23: 17Crossref (46) 1). Only 40% 60% those respectively, aware smaller proportions receiving target goals.11Gregg E.W. Buckley Ali M.K. al.Improving outcomes diabetes: setting WHO Diabetes Compact.Lancet. 2023; 401: 1302-1312Abstract (33) Scholar,12Geldsetzer P. Manne-Goehler Marcus M.E. state 44 low-income countries: cross-sectional nationally representative individual-level 1.1 adults.Lancet. 394: 652-662Abstract (302) Moreover, 3 diabetes CKD.13Chu Bhogal S.K. Lin al.AWAREness Diagnosis Treatment Adults With Type 2 (AWARE-CKD T2D).Can J Diabetes. 46: 464-472Abstract (10) large proportion can prevented through healthy lifestyles, control factors, avoidance injury, optimization maternal child health, mitigation climate change, addressing social structural determinants health.3Luyckx Nevertheless, benefits measures seen generations come. meantime, stratification create opportunities institute therapies slow, halt, reverse CKD.14Levin A. Bonventre al.Global 2017 beyond: roadmap closing gaps care, research, policy.Lancet. 390: 1888-1917Abstract (656) Concerningly, awareness strikingly low ≈80% 95% being across world regions 2).15Stengel B. Muenz D. Tu al.Adherence Disease: Improving Outcomes guideline nephrology practice countries.Kidney Int Rep. 6: 437-448Abstract (23) Scholar, 16Chu C.D. Chen M.H. McCulloch C.E. al.Patient CKD: review meta-analysis patient-oriented questions setting.Kidney Med. 3: 576-585.e1Abstract (27) 17Ene-Iordache Perico Bikbov al.Chronic cardiovascular six (ISN-KDDC): study.Lancet Health. 2016; 4: e307-e319Abstract 18Gummidi John O. Ghosh prevalence Uddanam, India.Kidney 5: 2246-2255Abstract (21) 19Kidney (KDIGO) Work GroupKDIGO 2022 Clinical Practice Guideline Management Disease.Kidney 102: S1-S127PubMed 20Nicholas S.B. Daratha K.B. Alicic R.Z. al.Prescription guideline-directed medical CURE-CKD Registry, 2019-2020.Diabetes Obes Metab. 25: 2970-2979Crossref People dying missed detect deliver optimal care! More important, major KF become competing risks.21Grams Yang W. Rebholz C.M. al.Risks adverse events advanced Insufficiency Cohort (CRIC) study.Am Dis. 70: 337-346Abstract (53) Indeed, 2019 showed died dysfunction (1.7 people) itself (1.4 people).2Institute Therefore, priority CKD. Strategies built on strong base past decades 3).19Kidney Scholar,22Kidney Group. KDIGO 2024 Disease. https://doi.org/10.1016/j.kint.2023.10.018Google clear; however, adherence suboptimal Scholar,19Kidney Scholar,20Nicholas Regardless cause, hypertension, forms foundation CKD.19Kidney Scholar,23Kidney Blood Pressure disease.Kidney 99: S1-S87PubMed Beyond lifestyle changes control, initial pharmacologic classes agents proven provide protection renin-angiotensin-aldosterone inhibitors form angiotensin-converting enzyme (ACEIs) angiotensin receptor blockers.14Levin despite knowledge medications important protective effects heart function use remained based real-world electronic records 2). For example, ACEI blocker 20% ≥15 after last approvals type diabetes.24Tuttle K.R. Duru O.K. al.Clinical characteristics adults children: registry.JAMA Netw Open. 2e1918169Crossref (134) show improvement prescribing 70% population, just persist 90 days.20Nicholas illustrate both medication continuity time, potentially related cost, education, polypharmacy, effects.25Ismail W.W. Witry M.J. Urmie J.M. association sharing, prior authorization, specialty drug utilization: review.J Manag Care Spec Pharm. 29: 449-463PubMed enthusiasm sodium-glucose cotransporter (SGLT2) focused unprecedented therapeutic clearly observed well. relative reductions SGLT2 approach substantial decline glomerular filtration rate, KF, populations several causes, risk.26Heerspink H.J.L. Vart Jongs al.Estimated lifetime benefit novel pharmacological disease: joint randomized controlled trials.Diabetes 3327-3336Crossref (11) Scholar,27Nuffield Department Population Studies GroupSGLT2 Inhibitor Meta-Analysis Cardio-Renal Trialists' Consortium. Impact sodium co-transporter-2 outcomes: collaborative placebo-controlled trials.Lancet. 400: 1788-1801Abstract (294) accrued top standard-of-care inhibitor. Risks all-cause reduced CKD.26Heerspink Addition inhibitor by years, depending when they started.28Fernández-Fernandez Sarafidis Soler al.EMPA-KIDNEY: expanding inhibitors.Clin 16: 1187-1198Crossref every 1000 standard therapy, 83 deaths, 19 hospitalizations, 51 initiations, 39 episodes worsening prevented.29McEwan Boyce Sanchez J.J.G. al.Extrapolated longer-term DAPA-CKD trial: modelling analysis.Nephrol Dial Transplant. 38: 1260-1270Crossref marked underuse other guideline-recommended therapies, including inhibitors, persists 2).20Nicholas Scholar,24Tuttle registry, 5% 6.3% eligible continued glucagon-like peptide-1 agonist days.18Gummidi Notably, commercial insurance community-based versus academic institutions associated lower likelihoods , ACEI, prescriptions CKD.20Nicholas low- countries (LMICs), implementation wider given inconsistent availability medications, generics.30Vanholder Braks al.Inequities care.Nat 19: 694-708Crossref (8) Such unacceptable. addition nonsteroidal mineralocorticoid antagonists demonstrated reduce risks events, diabetes.31Agarwal Filippatos G. Pitt al.Cardiovascular finerenone FIDELITY pooled analysis.Eur Heart 43: 474-484Crossref (372) growing portfolio promising options horizon agonists (NCT03819153, NCT04865770), aldosterone synthase (NCT05182840), dual-to-triple incretins (Supplementary Table S1).26Heerspink Scholar,32Tuttle Bosch-Traberg H. Cherney D.Z.I. al.Post hoc SUSTAIN 6 PIONEER trials suggests semaglutide experience stable compared placebo.Kidney 103: 772-781Abstract Furthermore, already clear safe glucose-lowering aid weight loss.32Tuttle taken practice.33Rubin It change practice-the burgeoning field science seeks speed things up.JAMA. 329: 1333-1336Crossref (26) millions year, long wait. Since launch Organization Action Plan Non-Communicable Diseases (NCDs) 2013, progress NCD plan dedicated units.34World OrganisationMid-point evaluation noncommunicable 2013–2020 (NCD-GAP).https://cdn.who.int/media/docs/default-source/documents/about-us/evaluation/ncd-gap-final-report.pdf?sfvrsn=55b22b89_5&download=trueDate incorporated into strategies approximately one-half countries.4International Policies required integrate within essential packages under universal coverage 4).30Vanholder Multisectoral policies address which amplifiers severity, limiting people's Lack investment promotion, along secondary hinders progress.14Levin Two goals achieve services financial hardship imposed care. alone insufficient ensure adequate care.3Luyckx strengthened prioritized, poor contributes low-resource settings.35Kruk Gage A.D. Joseph N.T. al.Mortality due low-quality era: amenable countries.Lancet. 392: 2203-2212Abstract (482) Quality requires well-trained workforce, accurate diagnostics, reliable infrastructure, supplies should monitored ongoing process 4). LMICs, additional barrier successful CKD.36Kingori Peeters Grietens K. Abimbola S. al.Uncertainties about products globally: lessons multidisciplinary research.BMJ Glob 6e012902Crossref (7) Regulation monitoring manufacturing standards therapies. support regulation assurance will local contexts guidance, outlined elsewhere.37Pan American medicines.https://www.paho.org/en/topics/quality-control-medicinesDate Establishing credible case risks, interventions outcomes, costs, data, help translate theoretical cost-effectiveness (currently established primarily high-income minimal elsewhere) reality.30Vanholder Scholar,38Tuttle Wong St Peter al.Moving breakthrough diabetic disease.Clin Am Soc 17: 1092-1103Crossref (31) Screening include eliciting family history, recognizing potential symptoms (usually advanced—fatigue, appetite, edema, itching etc.), measuring pressure, serum creatinine, urinalysis, urine albumin/protein creatinine ratios, guidelines.19Kidney Scholar,39Kalyesubula Conroy A.L. Calice-Silva V. al.Screening countries.Semin 42151315Abstract Addressing upstream reducing KF. Medications included Essential Medication List (Table provided levels coverage.40Francis Abdul Hafidz M.I. Ekrikpo U.E. al.Barriers accessing medicines 969-973Abstract (13) Pharmaceutical companies affordable prices.Table 1Essential diseaseMedication/technologyExampleReasonOn model list medicinesACE inhibitorEnalapril, lisinoprilDelays strokeYesAngiotensin blockerLosartan, telmisartanDelays strokeYesCalcium channel blockerAmlodipine, verapamilBlood controlYesLoop diureticsFurosemide, torsemideGood GFR low, good failureYesThiazide diureticsHydrochlorothiazide, metolazone, indapamideGood BP, Black populationYesSGLT2 inhibitorEmpagliflozin, canagliflozin, dapagliflozinDiabetes delays deathYesGLP1 agonistSemaglutideDiabetes lossNoMineralocorticoid inhibitorSpironolactone, finerenoneDelays reduces riskCaution: hyperkalemia diseaseYes
Language: Английский