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Moving from Evidence to Implementation of Breakthrough Therapies for Diabetic Kidney Disease

Katherine R. Tuttle, Leslie Wong, Wendy St. Peter, Glenda Roberts, Janani Rangaswami, Amy Mottl, Alan S. Kliger, Raymond C. Harris, Patrick O. Gee, Kevin Fowler, David Cherney, Frank C. Brosius, Christos Argyropoulos and Susan E. Quaggin; on behalf of the Diabetic Kidney Disease Collaborative Task Force
CJASN July 2022, 17 (7) 1092-1103; DOI: https://doi.org/10.2215/CJN.02980322
Katherine R. Tuttle
1Providence Medical Research Center, Providence Health Care
2Nephrology Division and Kidney Research Institute, University of Washington, Seattle, Washington
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Leslie Wong
3Department of Kidney Medicine, Cleveland Clinic, Cleveland, Ohio
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Wendy St. Peter
4Department of Pharmaceutical Care and Health Systems, College of Pharmacy, University of Minnesota, Minneapolis, Minnesota
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Glenda Roberts
2Nephrology Division and Kidney Research Institute, University of Washington, Seattle, Washington
5Center for Dialysis Innovation and the Justice, Equity, Diversity, and Inclusion Center for Transformative Research, Kidney Research Institute, University of Washington, Seattle, Washington
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Janani Rangaswami
6Nephrology Division, George Washington University School of Medicine, Washington, DC
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Amy Mottl
7Nephrology Division, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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Alan S. Kliger
8Nephrology Division, Yale University School of Medicine, New Haven, Connecticut
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Raymond C. Harris
9Nephrology Division, Vanderbilt University Medical Center, Nashville, Tennessee
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Patrick O. Gee
10iAdvocate, Inc.
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Kevin Fowler
11The Voice of the Patient, Inc.
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David Cherney
12Nephrology Division, Toronto General Hospital, Toronto, Ontario, Canada
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Frank C. Brosius III
13Nephrology Division, University of Arizona, Tucson, Arizona
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Christos Argyropoulos
14Nephrology Division, University of New Mexico, Albuquerque, New Mexico
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Susan E. Quaggin
15Nephrology Division, Northwestern University, Evanston, Illinois
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Abstract

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.

  • diabetic nephropathy
  • ACE inhibitors
  • cardiovascular disease
  • SGLT2 inhibitors
  • GLP-1 receptor agonists
  • non-steroidal mineralocorticoid antagonist
  • angiotensin receptor blockers
  • albuminuria
  • disparity
  • Copyright © 2022 by the American Society of Nephrology
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Clinical Journal of the American Society of Nephrology: 17 (7)
Clinical Journal of the American Society of Nephrology
Vol. 17, Issue 7
July 2022
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Moving from Evidence to Implementation of Breakthrough Therapies for Diabetic Kidney Disease
Katherine R. Tuttle, Leslie Wong, Wendy St. Peter, Glenda Roberts, Janani Rangaswami, Amy Mottl, Alan S. Kliger, Raymond C. Harris, Patrick O. Gee, Kevin Fowler, David Cherney, Frank C. Brosius, Christos Argyropoulos, Susan E. Quaggin
CJASN Jul 2022, 17 (7) 1092-1103; DOI: 10.2215/CJN.02980322

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Moving from Evidence to Implementation of Breakthrough Therapies for Diabetic Kidney Disease
Katherine R. Tuttle, Leslie Wong, Wendy St. Peter, Glenda Roberts, Janani Rangaswami, Amy Mottl, Alan S. Kliger, Raymond C. Harris, Patrick O. Gee, Kevin Fowler, David Cherney, Frank C. Brosius, Christos Argyropoulos, Susan E. Quaggin
CJASN Jul 2022, 17 (7) 1092-1103; DOI: 10.2215/CJN.02980322
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  • Article
    • Abstract
    • Introduction
    • Unmet Needs for Practice, Policy, and Research in Diabetic Kidney Disease
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More in this TOC Section

  • Keys to Driving Implementation of the New Kidney Care Models
  • Digenic Alport Syndrome
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Keywords

  • diabetic nephropathy
  • ACE inhibitors
  • cardiovascular disease
  • SGLT2 inhibitors
  • GLP-1 receptor agonists
  • non-steroidal mineralocorticoid antagonist
  • angiotensin receptor blockers
  • albuminuria
  • disparity

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