Division of Nephrology, Department of Medicine, University of Washington, Seattle, WA; Kidney Research Institute, University of Washington, Seattle, WA.
Department of Medicine, University of California, San Francisco, CA; Kidney Health Research Collaborative, University of California, San Francisco, CA.
Semin Nephrol. 2024 Mar;44(2):151520. doi: 10.1016/j.semnephrol.2024.151520. Epub 2024 May 5.
Chronic kidney disease (CKD) is highly prevalent, estimated to affect over 800 million people worldwide. Diabetes is a leading cause of kidney disease. Both diabetes and CKD are associated with a high risk of cardiovascular disease and related morbidity and mortality. Over the last several years, there has been a shift in focus toward integrating kidney and cardiovascular care, particularly in diabetes. Sodium-glucose cotransporter 2 inhibitors, glucagon-like peptide 1 receptor agonists, and nonsteroidal mineralocorticoid receptor antagonists have rapidly become cornerstones of kidney and cardiovascular risk-focused care in diabetes and CKD. However, present-day use of these agents is low, and disparities in use by race, ethnicity, age, sex, and comorbidities are apparent. Challenges in implementation of kidney protective and cardioprotective therapies include low rates of diabetes and CKD screening, lack of provider comfort and subspecialty reliance, inconsistencies across professional society guidelines, high rates of drug discontinuation, and prohibitive costs. Effective implementation of kidney protective and cardioprotective therapies necessitates a multifaceted approach and active engagement of patients, pharmacists, primary care providers, subspecialty providers, and health care system leaders as key stakeholders. Implementation efforts should be practical and incorporate collaborative, multidisciplinary team-based approaches. Successful implementation of kidney protective and cardioprotective therapies has the potential to improve overall health outcomes and ameliorate health care disparities.
慢性肾脏病（CKD）发病率极高，据估计全球有超过 8 亿人受其影响。糖尿病是导致肾脏疾病的主要原因之一。糖尿病和 CKD 都与心血管疾病风险增加以及相关发病率和死亡率升高相关。在过去几年中，人们的关注点逐渐转向肾脏和心血管疾病的综合治疗，尤其是在糖尿病领域。钠-葡萄糖共转运蛋白 2 抑制剂、胰高血糖素样肽 1 受体激动剂和非甾体类盐皮质激素受体拮抗剂已迅速成为糖尿病和 CKD 中以肾脏和心血管风险为重点的治疗的基石。然而，目前这些药物的使用率较低，且在种族、民族、年龄、性别和合并症方面的使用存在差异。实施肾脏保护和心脏保护治疗的挑战包括糖尿病和 CKD 筛查率低、提供者缺乏舒适度和对亚专业的依赖、专业学会指南之间存在差异、药物停药率高以及费用过高。有效实施肾脏保护和心脏保护治疗需要采取多方面的方法，并让患者、药剂师、初级保健提供者、亚专业提供者和医疗保健系统领导者等关键利益相关者积极参与。实施工作应注重实际，采用协作式、多学科团队为基础的方法。成功实施肾脏保护和心脏保护治疗有可能改善整体健康结果并减轻医疗保健差异。
