• 1.

    GBD 2017 Disease and Injury Incidence and Prevalence Collaborators. Global, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990–2017: A systematic analysis for the Global Burden of Disease Study 2017. Lancet 2018; 392:17891858. doi: 10.1016/S0140-6736(18)32279-7

    • Search Google Scholar
    • Export Citation
  • 2.

    Xie Y, et al. Analysis of the Global Burden of Disease study highlights the global, regional, and national trends of chronic kidney disease epidemiology from 1990 to 2016. Kidney Int 2018; 94:567581. doi: 10.1016/j.kint.2018.04.011

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 3.

    Tuttle KR, et al. Clinical characteristics of and risk factors for chronic kidney disease among adults and children: An analysis of the CURE-CKD registry. JAMA Netw Open 2019; 2:e1918169. doi: 10.1001/jamanetworkopen.2019.18169

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 4.

    Perkovic V, et al. Canagliflozin and renal outcomes in type 2 diabetes and nephropathy. N Engl J Med 2019; 380:22952306. doi: 10.1056/NEJMoa1811744

  • 5.

    Heerspink HJL, et al., for the DAPA-CKD Trial Committees and Investigators. Dapagliflozin in patients with chronic kidney disease. N Engl J Med 2020; 383:14361446. doi: 10.1056/NEJMoa2024816

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 6.

    Bakris GL, et al. Effect of finerenone on chronic kidney disease outcomes in type 2 diabetes. N Engl J Med 2020; 383:22192229. doi: 10.1056/NEJMoa2025845

    • Crossref
    • Search Google Scholar
    • Export Citation

ASN Diabetic Kidney Disease Task Force Embracing the Promise of Kidney Health

  • 1 Katherine R. Tuttle, MD, FASN, FACP, FNKF, is Chair of the ASN Diabetic Kidney Disease Collaborative (DKD-C) Task Force. Bonnie Freshly is an ASN Excellence in Patient Care Project Associate.
Full access

The past 18 months have brought to the kidney community an explosion of innovative therapies that have ushered in a wave of promise for the treatment of diabetic kidney diseases (DKDs).

Globally, 476 million adults are living with diabetes (1), of whom 40% will develop DKD (2). The impact of DKD on patient quality of life is extensive, and the care of these patients is complex, requiring the thoughtful intersection of specialties and ongoing communication for quality management of care.

To date, the standard of care for treatment of DKD has been an angiotensin-converting enzyme (ACE) inhibitor or an angiotensin II receptor blocker (ARB), yet these agents remain underutilized in clinical practice (3).

A series of trials clearly demonstrate that sodium-glucose co-transporter-2 inhibitors (SGLT2is) and non-steroidal mineralocorticoid antagonists (MRAs) improve survival along with kidney and heart health. Notably, the Dapagliflozin and Prevention of Adverse Outcomes in Chronic Kidney Disease (DAPA-CKD) trial also extended these observations to non-diabetic patients with albuminuric CKD.

  • CREDENCE (SGLT2i): Canagliflozin reduced risks of substantial loss of kidney function, kidney failure and death due to kidney disease, and cardiovascular (CV) outcomes (4).

  • DAPA-CKD (SGLT2i): Dapagliflozin reduced risks of substantial loss of kidney function, kidney failure, hospitalization for heart failure, and death from CV and all causes (5).

  • FIDELIO (non-steroidal MRA): Finerenone reduced risks of substantial loss of kidney function, kidney failure, kidney disease death, and CV outcomes (6).

To disseminate knowledge about these new therapies and brainstorm with the provider community on best practices to increase prescription of SGLT2is and MRAs to patients with DKD, the American Society of Nephrology (ASN) Diabetic Kidney Disease Collaborative (DKD-C) Task Force convened a series of three strategy conferences in 2020 and 2021. Each of these conferences assembled a multi-disciplinary group of stakeholders, including nephrologists, government representatives, pharmacists, healthcare system leaders, patient advocates, and industry partners. The second conference invited partnership with primary care providers, and the third highlighted collaboration with cardiologists and endocrinologists.

  1. The first strategy conference, which was held in Washington, DC, in January 2020, defined barriers and solutions. For example, barriers in early identification may be addressed by earlier referrals and recruitment of local champions. A position paper highlighted a set of deliverables, including development of educational materials and a patient-oriented campaign.

  2. The second conference, which highlighted collaboration with primary care providers, took place virtually on April 20, 2021. Outcomes included the identification of DKD care best practices and recommendations for the implementation of new therapies for DKD.

  3. The capstone conference took place virtually on June 16, 2021. Conference participants considered a multispecialty approach to ensure the implementation of therapies.

The DKD-C Task Force will soon release its summation of these conferences, highlighting barriers such as therapeutic inertia in a fragmented silo care model, high costs, and inconsistent messaging and data. The Task Force will recommend constructively disruptive solutions to improve healthcare delivery. Throughout all recommendations, the importance of engaging and educating patients is of primary importance. The ASN DKD-C Task Force challenges healthcare colleagues to embrace the promise of SGLT2i and MRA therapies by establishing them as a standard of care for DKD.

With each conference identifying a need for greater education, the Task Force has embarked on development of a web-based educational module for DKD. Under the direction of Chairs Dr. Amy Mottl and Dr. Christos Argyropoulos, this module utilizes a case-based strategy focused on the patient journey:

  • Diagnosis and Pathophysiology

  • Diet, Exercise, Medical Weight Management

  • Racial and Socioeconomic Disparities

  • Awareness, Detection, and Intervention

  • Glycemic Targets

  • Glucose-lowering Agents (including SGLT2i)

  • Hypertension Treatment

  • Renin-Angiotensin System Blockade (including ACE inhibition, ARBs, and MRAs)

  • CV Disease Evaluation and Treatment

  • Acute Kidney Injury, Nephrotic Syndrome, and Indications for Kidney Biopsy

The module will feature knowledge checks that prompt the learner to consider treatment strategies for clinical case scenarios. As new therapies emerge, the module will be updated to reflect current evidence.

The advent of breakthrough therapies for DKD has ushered in an exciting new era for patients and healthcare professionals. The ASN DKD-C Task Force, through initiatives such as the strategy conference series and the DKD education module, is a trustworthy source of information, communication, and collaboration across specialties and disciplines that together aspire to achieve better health and life for patients with DKD.

ASN DKD-C Task Force members

Katherine R. Tuttle, MD, FASN (Chair); Frank C. (Chip) Brosius, III, MD; David Cherney, MD, PhD; Patrick O. Gee, Sr., PhD, JLC; Raymond C. Harris, MD, FASN; Alan S. Kliger, MD; and Susan E. Quaggin, MD, FASN

References

  • 1.

    GBD 2017 Disease and Injury Incidence and Prevalence Collaborators. Global, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990–2017: A systematic analysis for the Global Burden of Disease Study 2017. Lancet 2018; 392:17891858. doi: 10.1016/S0140-6736(18)32279-7

    • Search Google Scholar
    • Export Citation
  • 2.

    Xie Y, et al. Analysis of the Global Burden of Disease study highlights the global, regional, and national trends of chronic kidney disease epidemiology from 1990 to 2016. Kidney Int 2018; 94:567581. doi: 10.1016/j.kint.2018.04.011

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 3.

    Tuttle KR, et al. Clinical characteristics of and risk factors for chronic kidney disease among adults and children: An analysis of the CURE-CKD registry. JAMA Netw Open 2019; 2:e1918169. doi: 10.1001/jamanetworkopen.2019.18169

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 4.

    Perkovic V, et al. Canagliflozin and renal outcomes in type 2 diabetes and nephropathy. N Engl J Med 2019; 380:22952306. doi: 10.1056/NEJMoa1811744

  • 5.

    Heerspink HJL, et al., for the DAPA-CKD Trial Committees and Investigators. Dapagliflozin in patients with chronic kidney disease. N Engl J Med 2020; 383:14361446. doi: 10.1056/NEJMoa2024816

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 6.

    Bakris GL, et al. Effect of finerenone on chronic kidney disease outcomes in type 2 diabetes. N Engl J Med 2020; 383:22192229. doi: 10.1056/NEJMoa2025845

    • Crossref
    • Search Google Scholar
    • Export Citation
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