The global burden of chronic kidney disease has nearly doubled over the past 30 years, and chronic kidney disease is now the ninth leading cause of death worldwide.1 In the United States, more than 1 in 10 adults has chronic kidney disease.2 It is associated with premature death as well as significant morbidity and reduced quality of life, and puts considerable strain on healthcare systems.
The dual obesity and diabetes epidemics have fueled the rising prevalence of chronic kidney disease, as individuals with diabetes are twice as likely to have chronic kidney disease compared with the general population.2 Emerging science has shown that common mediators and a complex interplay of pathobiology lead to progressive multiorgan injury, called cardiovascular-kidney-metabolic syndrome. Fortunately, medical advancement has produced new tools for the toolbox (beyond angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers) to delay loss of kidney function and even preserve kidney and cardiovascular health. This puts pressure on clinicians in endocrinology, cardiology, and nephrology to harmonize life-saving therapeutic strategies for broad and effective implementation.
Recognizing the need for new management strategies to reduce the burden of chronic kidney disease and improve patient outcomes, the 2024 Kidney Disease: Improving Global Outcomes (KDIGO) guideline3 updates the chronic kidney disease classification framework introduced in 20124 to aid the detection, risk stratification, and management of chronic kidney disease based on estimated glomerular filtration rate using both creatinine and cystatin C and albuminuria. Although risk stratification and prediction tools, like the KDIGO heat map and the Kidney Failure Risk Equation, aim to guide clinicians and increase patient awareness, they are rarely used. Consequently, about 87% of Americans with chronic kidney disease are unaware that their kidney health is at risk.2
A CLARION CALL FOR EARLY DETECTION AND INTERVENTION
The healthcare community needs to adopt early interventions that can alter the course of chronic kidney disease for patients. In this issue of the Journal, Galindo and colleagues5 summarize key strategies from the comprehensive 2024 KDIGO guideline3 to help busy clinicians across multiple specialties collaboratively manage kidney disease and cardiovascular-kidney-metabolic syndrome. Specifically, the authors urge primary care clinicians to screen at-risk patients for early detection of chronic kidney disease and focus on using the KDIGO heat map to appropriately initiate medical therapy.
Classifying chronic kidney disease stage and stratifying patient risk with the heat map are the foundation of tailoring guideline-directed medical therapy for maximal cardiovascular-kidney-metabolic benefit. However, the proliferation of available treatments and guidelines focused on specific organs has increased management complexity and risks creating confusion and inertia among clinicians. To help navigate this, Galindo and colleagues5 provide a simplified treatment algorithm as well as a table that combines the latest American Diabetes Association and KDIGO treatment recommendations to tailor multidrug therapy for patients with chronic kidney disease and associated comorbid conditions like type 2 diabetes. Until we have fully harmonized cross-specialty therapeutic approaches to manage cardiovascular-kidney-metabolic syndrome, the strategies outlined by the authors are an evidence-based path forward for immediate implementation of coordinated care.
The authors also suggest embedding guideline-directed prediction models and alerts in electronic medical record systems along with integrating artificial intelligence that automatically prompts urine screening orders based on certain risk factors to facilitate early detection and intervention for at-risk patients. However, limited access to new drugs due to insurance barriers has and will continue to delay treatment and threatens to widen health disparities. As in other areas of medical advancement, health policies that support equal access and affordability are needed to achieve the best outcomes for all patients, especially those in the United States.
THE FUTURE LOOKS BRIGHT
Nonetheless, the tide is turning on the global burden of chronic kidney disease with new treatment strategies outlined by the 2024 update to the KDIGO guideline,3 which are well-summarized for easy use in daily practice by Galindo and colleagues.5 Let the heat map colors be your visual guide to enhance patient care.
DISCLOSURES
Dr. Gadegbeku has disclosed being an advisor or review panel participant for Maze Therapeutics and Vertex Pharmaceuticals, research as an investigator and protocol committee advisor for Maze Therapeutics, and research for Vertex Pharmaceuticals.
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