Tim Smith joined the MJH Life Sciences team in 2022 and is currently an associate editor for HCPLive. He is also the executive producer of two podcasts: Skin of Color Savvy and The Medical Sisterhood. Previously, he was the producer of the Lungcast podcast. He graduated from UC Berkeley and worked in multimedia journalism as a staff writer prior to joining MJH. You can contact him at tsmith@mjhlifesciences.com.

Telemedicine use among patients has expanded dramatically in recent years, and the practice’s ability to expand access to patients regardless of location has shifted the way medicine is practiced.

Despite the explosion of telemedicine’s implementation, especially during the COVID-19 pandemic, concerns have arisen regarding the value of this practice as opposed to the value of in-person interactions with clinicians.

 While the practice may have expanded access to care, the limits of telemedicine and telehealth in general have become increasingly more apparent.

, a visually dependent subfield of medicine, is uniquely suited for the virtual health care model, and its integration has been dubbed ‘teledermatology.’ This technological advancement in the field of medicine, commonly involving virtual appointments and app-based instructions, can allow a diverse patient population access to dermatology care.

In this feature, the editorial team reached out to 3 speakers in the field of dermatology to provide commentary on the evolution of teledermatology. One speaker was Harrison Nguyen, MD, MBA, MPH, a double board-certified dermatologist, Mohs micrographic surgeon, and clinical researcher in Houston, Texas. Nguyen also serves as a clinical assistant professor of dermatology at the Baylor College of Medicine.

 also spoke with Sylvana A. Brickley, DNP, FNP-BC, DCNP, a dermatology certified nurse practitioner (NP) at Lahey Health, and Avery Dinallo, DNP, FNP-C, DCNP, a dual board-certified family NP, a dermatology NP, and the president-elect of the Society of Dermatology Nurse Practitioners (SDPA).

These 3 leaders in the dermatology space provided several helpful insights on the ever-changing topic of telemedicine and teledermatology, highlighting the strengths and weaknesses of the practice and describing where improvements can be made to the practice to ensure adequate care.

Although teledermatology exploded in use during the COVID-19 pandemic, the practice predates 2020, with the term initially appearing in medical literature in 1993 and gaining traction in Norway.

 However, the first formal guidelines regarding teledermatology were issued by the American Telemedicine Association in 2007.

As innovations related to home computer use and smartphone adoption increased dramatically in the late 2000s and early 2010s, telemedicine became more and more of a reality. The COVID-19 pandemic was, undoubtedly, the inflection point for teledermatology’s use.

The aforementioned guidelines, when updated in 2016, began referring to 3 forms of consultation typically seen in teledermatology: real-time videoconferencing, store and forward, and a hybrid of these 2 methods.

 Store-and-forward is known to be the most widely utilized, involving taking photographs or videos, which are then evaluated at a different time and location.

In his interview, Nguyen explains how, despite technological advances, inconsistent reimbursement practices kept adoption fragmented in the period before 2020. He also highlights Medicare's reliable reimbursement during the pandemic, describing the move as setting a precedent followed by commercial insurers.

“It had been in existence before, but we had very inconsistent reimbursement, and adoption varied among practice types and varied among regions,” Nguyen explained. “But with COVID, it became a necessity. We started to really use it across more practice types, and we had very strong reimbursement from that, which started when Medicare was reimbursing very, very reliably.”

, Brickley and Dinallo both provide a practitioner's impression of what the COVID-era rush into telehealth actually looked like from within a clinic.

"It did explode,” Dinallo expressed. “It exploded during COVID, when everybody was forced to enter into these telehealth spaces.” Brickley concurred with Dinallo, describing the increasing adoption of telemedicine practices as a ‘mad rush’ in light of the pandemic.

Telemedicine has been used for a variety of aims: those working in healthcare settings can use the practice to monitor patient health, to provide clinical services to patients, to consult with other providers, and to allow patients to have access to various educational resources. Perhaps most significantly, in the dermatology world, telemedicine practices can allow for efficient diagnoses of diseases such as psoriasis, rosacea, atopic dermatitis, and skin cancer.

Skin cancer, for example, is a uniquely important condition for dermatologists to diagnose, given the increasing incidence and real concerns over morbidity among patients.

 Multiple studies have demonstrated high concordance between teledermatology and in-person diagnoses, with 1 finding 91% concordance.

Patients have also reported a high level of satisfaction with teleconsultations, with increased savings related to travel, diminished wait times, and time efficiency being cited specifically.

 In his interview, Nguyen generally concurred with these views, outlining the conditions well suited to telehealth and noting medication and biologic monitoring, as well as post-procedure follow-up, are strengthened by the practice.

Brickley and Dinallo reinforced this view as well from their own clinical experience and practice focus, highlighting evidence supporting telemedicine for acne and rosacea specifically. Both also touched on the value telemedicine has brought to underserved communities

"Many dermatology practices, you're waiting three months, six months to get seen, or they live so far away they don't want to make that commute,” Dinallo said. “It's a lot easier just to pop on a call."

Brickley agreed, describing virtual consults as helping to decrease the number of referrals to dermatology practices. Such consults can free up in-person appointments for individuals who more urgently need to be seen by a dermatology provider, she highlighted.

An important consideration of adopting any new technological innovation is awareness of downsides. As tools such as smartphones have become more widely accepted in everyday life by most Americans, for example, the negative effects of their implementation related to emotional and cognitive health have become more apparent.

In the same vein, the limits of teledermatology require exploration to better understand the practice’s long-term impact on the medical field and on patients’ lives. Additionally, understanding these limits can help to improve the different facets of teledermatology’s use, allowing for improvements to the practice.

Despite the previously cited successes of virtual lesion assessments, research suggests in-person diagnostic accuracy remains approximately 11% greater than teleconsultations.

 Additionally, while diagnosing various conditions such as acne, psoriasis, and different skin cancers can be improved by teleconsultations, full body skin exams, melanocytic lesion assessments without dermoscopy, new or unclear rashes, and anything requiring a biopsy or procedure still necessitate in-person meetings.

During her interview, Brickley noted that still photos outperform video for diagnostic purposes. Nevertheless, she noted, modern smartphone cameras fall short of in-person evaluation for anything past classic presentations. Both Brickley and Dinallo note providers practicing solely through telemedicine carry a responsibility to refer patients to in-person care when necessary.

Nguyen frames most issues with telemedicine as a deployment problem, as much as a technology problem. He describes such practices as not inherently flawed, pointing to the placement of teledermatology in the wrong clinical context as producing redundant visits at best and missed diagnoses at worst.

"It falls short whenever it's being deployed under the wrong clinical context, when there's not the right triaging or workflows to identify the appropriate patient and appropriate care processes,” Nguyen expressed.

One of the more pointed critiques emerging from the interview with Dinallo and Brickley was regarding the proliferation of telemedicine platforms described by the 2 speakers as ‘prescription mills,’ wherein individuals can select a treatment, submit a photo or intake form, and be prescribed a medication without clinical conversation.

"There are companies out now where you just go, you click the drug you want, you text someone about it, and they mail it to your house,” Dinallo noted. “That's where it's been for the last 10 years, and it's gone too far in that direction."

Brickley concurred, noting that clinicians “want to satisfy the consumer, but also want to practice good medicine.” Practicing good medicine, Brickley added, is not always giving an individual who is asking for something exactly what they want. In other words, a commitment to scrupulous prescription practices is vital where telemedicine adoption is concerned, and this includes dermatology.

Brickley and Dinallo noted the founding rationale for their own telehealth clinic, AllMe Health, as correcting the market’s tilt toward convenience at the expense of genuine care. Examples include patients given tretinoin without guidance on how to use it, or ordering unnecessary labs with no clinician to interpret the data. Their clinic, they assert, will help to address these types of situations while still providing access to dermatologic care for underserved communities.

Obstacles to Teledermatology’s Expansion

Some of the most important issues related to teledermatology as a practice in today’s world lie not in its implementation, when warranted, but in the obstacles preventing its implementation.

Specifically, teledermatology reimbursement has been less than optimal for some dermatology clinicians, attributed to inconsistent payment parity between in-person consultations and teleconsultations. Reimbursement, Nguyen noted in his 

 interview, is the single biggest barrier to teledermatology’s more widespread use among those who need it.

"Teledermatology often takes as much time and resources to be able to do it as in-person visits,” Nguyen said. “It is not so different from a time and resource perspective."

Prior to the COVID-19 pandemic, inconsistent reimbursement kept teledermatology use limited, with fewer than 4% of dermatologists utilizing live video conferencing.

 During the pandemic, the Centers for Medicare & Medicaid Services (CMS) expanded payment parity under public health emergency waivers, a move driving 43 US states to adopt permanent coverage parity laws and 22 states to initiate explicit payment parity legislation.

Nevertheless, given the benefits cited by Nguyen and a significant amount of available data on telemedicine’s implementation, the appropriate reimbursement for asynchronous teledermatology assessment services remains a concern for many clinicians.

Adding to the discussion of obstacles to teledermatology, Brickley and Dinallo described an NP-specific licensure issue: the lack of a multi-state compact for NPs and the current presence of individual state licensing for every jurisdiction where NPs see patients. This, they note, is a time-consuming and expensive process.

“We don't have a compact for nurse practitioners where we can,” Brickley highlighted. “We have to get every single state license individually. You can only see a patient [for whom] you're licensed in the state where the patient is located."

Such obstacles remain a concern among dermatology clinicians and, in the coming years, may need to be addressed by US public health organizations.

Looking Toward the Future of Telemedicine

The demand for dermatology clinicians is high, due to population aging and increasing skin cancer rates. Teledermatology is uniquely positioned as a necessary response to such concerns and concerns over financial costs among patients.

The geographic maldistribution of clinicians is not likely to self-correct, making sustained teledermatology infrastructure a significant long-term priority for policymakers. Additionally, the value of maintaining the patient-centric nature of medicine has been described by clinicians as vital to medicine’s future.

Brickley and Dinallo’s interview concluded with a prediction of what is to come for teledermatology practices, with Brickley predicting a trend toward niche, specialized teledermatology services rather than broad general platforms. Dinallo echoes this sentiment, framing passion-driven specialty care as the model most likely to provide genuinely improved outcomes.

“The future is going to be similar to what we're doing, where we're focusing more on specialty care, where people that are really passionate about this one specific topic [are] then providing it to more people,” Dinallo concluded in her interview.

Nguyen concluded his discussion of teledermatology by, first and foremost, reiterating his pro-telemedicine views. He describes such practices as an important tool in the modern medical world for maintaining access among underserved patients, provided it is used efficiently and with the patient’s best interests in mind.

“Efficiency depends on whether the practice, the health system, or the clinician has the infrastructure set up so that telemedicine is done in an efficient manner,” Nguyen explained. “I would say that access is something that has been demonstrated to improve with telemedicine. How do we continue to maintain the viability of it? We come back to the reimbursement aspect, making sure that clinicians are reimbursed appropriately for their efforts in teledermatology.”

Teledermatology's future may not be determined by the innovation itself, but by whether the policymakers, the payers, and the clinicians involved ensure its success. The screen is likely not to fully replace the exam room, but its helpfulness as a tool for clinicians may increase over time.

Kimball AB, Porter ML. Impact of the COVID-19 Pandemic on the Delivery of Dermatological Care. Curr Dermatol Rep. 2022;11(4):313-317. 

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Pala P, Bergler-Czop BS, Gwiżdż JM. Teledermatology: idea, benefits and risks of modern age - a systematic review based on melanoma. Postepy Dermatol Alergol. 2020 Apr;37(2):159-167. 

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Okobi OE, Abreo E, Okafor AA, et al. Trends in Melanoma Incidence, Prevalence, Stage at Diagnosis, and Survival: An Analysis of the United States Cancer Statistics (USCS) Database. Cureus. 2024 Oct 2;16(10):e70697. 

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Articles

Teledermatology has matured from early store-and-forward models into a pandemic-accelerated access modality with strong fit for visually driven disease assessment and longitudinal therapy monitoring. High diagnostic concordance and patient satisfaction are counterbalanced by measurable gaps versus in-person accuracy and clear limitations for total-body exams, equivocal eruptions, melanocytic lesions without dermoscopy, and procedural needs. Misdeployment and poor triage can create redundant visits or missed diagnoses. Sustained growth hinges on reimbursement parity, robust workflows, and curbing “prescription mill” practices.

In this feature, 3 experts discuss the expansion of telehealth and telemedicine use, including their positive and negative aspects in dermatology today.

Dermatology

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Where Teledermatology is Today: Expanding Access and Navigating Limits

Victoria Johnson joined the MJH Life Sciences in 2020 and has written for NeurologyLive, CGTLive, and now HCPLive. You can reach her at vjohnson@mjhlifesciences.com

 has not arrived evenly across care settings. While academic pulmonologists have been prescribing IL-5 antagonists and IL-4/IL-13 blockers for nearly a decade, the translation of that expertise into primary care, advanced practice, and multi-specialty clinical teams has lagged — shaped by differing prescribing privileges, patient populations, payer dynamics, and familiarity with rapidly evolving evidence. That translation gap matters enormously, because primary care and advanced practice providers represent the front line where severe asthma and chronic obstructive pulmonary disease (COPD) are most often first encountered, undertreated, and repeatedly managed with the short-term tool that remains most dangerous in the aggregate: oral corticosteroids (OCS). 

The approval of mepolizumab in 2015 established the first durable eosinophil-targeting option for severe asthma, followed by dupilumab's landmark FDA approvals — first for atopic dermatitis, then asthma in 2018, and most significantly for COPD in 2023, the first biologic ever cleared for that indication.

These milestones have changed what is pharmacologically possible; the harder task is ensuring that the right providers, across the full breadth of clinical practice, know when and how to deploy them.

To further explore potential gaps in care, 

a clinical forum discussing the evolving landscape of targeted therapy in asthma and COPD, moderated by Alanna Kavanaugh, MSN, BSN, CCRN, Assistant Dean of Graduate Nursing and Chair of the Family Nurse Practitioner Program, College of Mount Saint Vincent, and attended by a diverse group of nurse practitioners, advanced practice providers, and clinical educators from institutions including Weill Cornell, Stanford, Mount Sinai's World Trade Center Health Program, and a range of primary care and integrative practices across the Northeast. The forum touched on a number of subjects, particularly the cumulative harm of OCS use, the practicalities of biologic selection, and the growing need for structured steroid stewardship in outpatient practice.

The discussion arrived at a moment when the biologic toolbox has never been more full. Dupilumab's long-term data continues to accumulate across asthma, nasal polyps, and now COPD; tezepelumab has established itself as the agent for biomarker-negative severe asthma; and the December 2024 approval of depemokimab — a 6-month IL-5 agent — has introduced a dosing interval that could meaningfully change the adherence calculus for certain patient populations.

 At the same time, GOLD 2026 guidelines have stiffened COPD escalation criteria, removing prior tolerance for a single moderate-to-severe exacerbation and pushing the field toward earlier biologic consideration.

 The forum's participants reviewed clinical trial data, debated real-world prescribing strategies, and shared cases that illustrated both the transformative potential of these therapies and the persistent systemic barriers — insurance, infrastructure, patient reluctance, and incomplete provider awareness — that continue to leave eligible patients undertreated.

The forum's most viscerally impactful discussion centered not on biologic selection but on what precedes it: the cumulative harm of oral corticosteroids and the lack of systematic infrastructure to track it. Maureen George, PhD, AE-C, RN, Columbia School of Nursing’s framing of lifetime milligram thresholds — 500 mg as a caution zone, 1,000 mg as a serious-risk threshold reachable in as few as three high-dose courses — was new information for several primary care panelists, some of whom acknowledged they had not previously thought in cumulative terms. Panelists proposed a dedicated OCS tracking system analogous to New York's I-STOP narcotics registry, and the concept of "steroid stewardship" resonated broadly. 

“First of all, when you're getting a lot of prednisone, looking at the anxiety and the other type of dysregulation that takes place I think we need to be looking that here and seeing if a person responds in that way as well. I know it's not something that people usually talk about because we're so busy looking at the biomarkers because we want to get rid of the disease, but there is a relationship that exists between the dysregulation and the disease,” one participant said.

The group reviewed the full approved biologic landscape for asthma — dupilumab, mepolizumab, benralizumab, omalizumab, tezepelumab, and depemokimab — with dupilumab generating the most vivid clinical anecdotes, including a patient who regained their sense of smell after 20 years and another whose externally visible nasal polyps resolved within 4 to 6 months. Tezepelumab drew attention for its efficacy in biomarker-negative patients, with 1 panelist describing an oxygen-dependent patient who came off daytime oxygen entirely after starting the drug. Depemokimab's 6-month dosing was discussed primarily through the lens of adherence — specifically for college students, travelers, elderly patients, and those with logistical barriers to frequent injections.

In COPD, the conversation reflected both growing momentum and persistent uncertainty. The GOLD 2026 update — which now places any single moderate-to-severe exacerbation into Group E, eliminating prior tolerance — was highlighted as a meaningful escalation of urgency, and several panelists noted they are actively working to capture eligible patients before exacerbations compound. Dupilumab remained the preferred COPD biologic based on stronger FEV1 improvement data from BOREAS and NOTUS; mepolizumab's lower EOS threshold of 150 was noted as potentially useful in borderline patients, though FEV1 gains were comparatively modest. The forum's final polling question found that clinical workflow tools and training — followed closely by clearer patient selection algorithms — were the resources practitioners most needed to prescribe COPD biologics with confidence. 

Closing takeaways revealed an appetite for expanded scope: attendees raised questions about biologics in cystic fibrosis, the potential for probiotic/prebiotic co-therapy to reduce the immune suppression side effects of biologics, and the urgent need for long-term lung function trajectory data. For many in the room, the night's most durable lesson was simpler: far too many patients who would benefit from these therapies are still receiving repeat prednisone instead.

Eger K, Hashimoto S, Braunstahl GJ, et al. Mepolizumab for eosinophilic COPD with exacerbations (MATINEE). 

. 2024;391(1):21-31. doi:10.1056/NEJMoa2401300

Bhatt SP, Rabe KF, Hanania NA, et al; NOTUS Investigators. Dupilumab for COPD with type 2 inflammation. 

. 2024;390(24):2275-2283. doi:10.1056/NEJMoa2401304

Price DB, Trudo F, Voorham J, et al. Adverse outcomes from initiation of systemic corticosteroids for asthma: long-term observational study. 

. 2018;11:193-204. doi:10.2147/JAA.S176026

Wechsler ME, Menzies-Gow A, Brightling CE, et al. Evaluation of the efficacy and safety of depemokimab in patients with severe asthma with an eosinophilic phenotype (SWIFT-1 and SWIFT-2). 

. 2024;404(10471):2373-2385. doi:10.1016/S0140-6736(24)02063-4

Global Initiative for Chronic Obstructive Lung Disease. 

Global Strategy for Prevention, Diagnosis and Management of COPD: 2026 Report

Biologic therapy has expanded dramatically for severe asthma and now COPD, yet adoption remains uneven outside academic pulmonology. Primary care and advanced practice settings still rely heavily on repeated oral corticosteroid bursts, often without tracking cumulative exposure or appreciating lifetime risk thresholds. Newer agents broaden eligibility—tezepelumab for biomarker-negative asthma and depemokimab with 6‑month dosing to improve adherence—while COPD guidance is tightening, prompting earlier escalation. Persisting barriers include payer friction, workflow limitations, and unclear selection algorithms.

New biologics transform severe asthma and COPD, yet prednisone overuse persists—see practical selection tips and outpatient steroid stewardship gaps.

COPD

COPD condition center page, resources on the topics of medical news and expert insight into chronic obstructive pulmonary disease can be found. Content includes articles, interviews, videos, podcasts, and breaking news on COPD research, treatment, and drug development.

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Steroid Stewardship in Severe Airway Disease: The Case for Earlier Biologic Escalation

Tatyana Kushner, MD, is an associate professor of medicine in the division of gastroenterology and hepatology at Weill Cornell Medicine.

New Hope for Hepatitis D? Brelovitug and the AZURE Program

For clinicians managing hepatitis D virus (HDV) infection, the stakes are uniquely high. Unlike many other chronic viral hepatitides, HDV is widely recognized as the most aggressive form of viral hepatitis, often leading to rapid disease progression and severe long-term complications.

, Tatyana Kushner, MD, an associate professor of medicine in the division of gastroenterology and hepatology at Weill Cornell Medicine, explained how the inflammatory nature of the disease drives this aggressive clinical course. Patients frequently experience significant liver inflammation and elevated viral activity, accelerating progression to advanced liver disease.

Check out part 1 of the interview with Kushner 

“Delta hepatitis is the most rapidly progressive form of hepatitis,” Kushner explained, noting that clinicians commonly see complications develop earlier than expected compared with other viral infections.

The consequences can be striking in clinical practice. Kushner noted that she regularly encounters patients in their 30s and 40s who have already developed cirrhosis, an outcome far less common among individuals with isolated hepatitis B infection. Because HDV relies on hepatitis B virus for replication, coinfection can significantly worsen liver outcomes.

Given this aggressive trajectory, treatment goals focus on achieving both virologic and biochemical control. Ideally, she says therapies would reduce HDV RNA to undetectable levels while normalizing liver enzymes such as ALT, which reflect ongoing hepatic inflammation. Achieving these surrogate markers could ultimately translate into reduced risk of cirrhosis, hepatocellular carcinoma, and liver transplantation.

Emerging therapies are now being evaluated with these goals in mind. Kushner highlights brelovitug, an investigational monoclonal antibody being developed by Mirum Pharmaceuticals and currently studied in the AZURE program, as one of the most promising.

The global, registrational phase 3 clinical development program includes multiple open-label studies designed to assess the primary endpoint of combined virologic and biochemical response. Together, the studies are intended to support regulatory filings in the United States and Europe. Topline data from AZURE-1 and AZURE-4 are expected in 2H 2026, with a potential BLA submission and launch in the US in 2027.

The primary endpoint for both studies is the proportion of patients achieving combined virologic response and ALT normalization at week 24, comparing brelovitug with a delayed-treatment control group and consistent with FDA guidance for accelerated approval in HDV.

Patients enrolled in the study will remain on treatment beyond the 24-week primary endpoint, allowing investigators to evaluate longer-term outcomes. Secondary analyses will focus on safety and tolerability, which remain critical considerations given the limitations of historical treatments such as pegylated interferon.

Beyond traditional clinical endpoints, the trial will also examine exploratory measures including patient-reported outcomes and quality of life. Kushner emphasized that these assessments are particularly meaningful in HDV, where patients have historically faced years of uncertainty without effective treatment options.

Looking ahead, Kushner believes the field is approaching an important turning point. While early efforts are focused on establishing therapies that are both effective and tolerable, the long-term goal will be demonstrating improvements in hard clinical outcomes, such as reduced rates of cirrhosis and liver cancer.

“I think we're getting pretty close to having several treatment options that achieve those desired outcomes. Over the years, as patients stay on these treatments longer, we will really want to see hard clinical endpoints, improvement in fibrosis, decreased incidence of cirrhosis and liver cancer in patients who are on these treatments long term,” Kushner said. “I think it will be important to think about not just long term treatment options, but finite treatment options… Before we get there, finding treatments that, even if long term, can have meaningful clinical, beneficial endpoints, it will be a big accomplishment.”

Editors’ Note: Kushner reports relevant disclosures with Gilead, Abbvie, GSK, Ipsen, Mirum, and Madrigal.

World Health Organization. Hepatitis D. July 25, 2025. Accessed March 13, 2026. 

https://www.who.int/news-room/fact-sheets/detail/hepatitis-d

Mirum Pharmaceuticals. Mirum Pharmaceuticals Completes AZURE-1 Enrollment and AZURE-4 Screening in Phase 3 Program of brelovitug in Chronic Hepatitis Delta Virus. March 5, 2026. Accessed March 13, 2026. 

https://ir.mirumpharma.com/news/news-details/2026/Mirum-Pharmaceuticals-Provides-AZURE-Clinical-Program-Update-for-brelovitug-in-Chronic-Hepatitis-Delta-Virus/default.aspx

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With new therapies emerging for hepatitis D, Kushner discusses brelovitug’s potential and what will be learned from the phase 3 AZURE program.

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Inside the AZURE Program of Brelovitug for Hepatitis D, With Tatyana Kushner, MD

Abigail Brooks is an assistant managing editor for 

She joined MJH Life Sciences in August 2023 shortly after graduating from Monmouth University where she earned her BA in Communication with a concentration in Public Relations/Journalism and later an MA in Interactive Digital Media. She enjoys traveling, running, and reading books. She can be reached at abrooks@mjhlifesciences.com.

 has long been recognized as a major public health challenge, but recent scientific advances and evolving clinical frameworks have brought renewed attention to the condition. Clinicians are increasingly viewing CKD not as an isolated renal disorder but as part of a broader cardio-kidney-metabolic disease spectrum that connects kidney health with cardiovascular and metabolic risk.

During a recent clinical forum led by Muthiah Vaduganathan, MD, MPH, codirector of the Center for Cardiometabolic Implementation Science at Brigham and Women’s Hospital, experts discussed how these shifting perspectives are reshaping CKD care. The discussion highlighted the growing role of multidisciplinary collaboration, the impact of emerging therapies that can slow disease progression, and the persistent gaps that continue to limit early diagnosis and optimal treatment.

A central theme was the recognition of CKD as part of an interconnected cardiometabolic disease network. Conditions such as diabetes, hypertension, obesity, and cardiovascular disease frequently coexist with kidney dysfunction, creating overlapping pathways that accelerate disease progression. As a result, clinicians across cardiology, endocrinology, primary care, and nephrology increasingly share responsibility for identifying and managing CKD.

Panelists noted that this broader perspective elevates the importance of kidney health within chronic disease prevention and management while underscoring the need for stronger collaboration among specialties that have traditionally worked in parallel.

Another major focus of the forum was the rapid expansion of disease-modifying therapies for CKD. In recent years, several treatment classes have demonstrated the ability to slow kidney disease progression while also reducing cardiovascular risk. These advances represent a shift from managing complications toward directly targeting mechanisms of disease progression.

Experts noted that clinical trial data supporting these therapies have been compelling, leading guidelines to increasingly recommend earlier use in appropriate patients. However, panelists acknowledged that real-world adoption has not kept pace with the evidence.

Many eligible patients with CKD still do not receive guideline-recommended therapies, reflecting a persistent gap between evidence and clinical practice. Participants pointed to several contributing factors, including the complexity of modern CKD care and the challenge clinicians face in keeping pace with rapidly evolving evidence and treatment recommendations.

Fragmented care across specialties may also contribute to inconsistent treatment patterns. Patients with CKD often receive care from multiple providers, including primary care physicians, cardiologists, endocrinologists, and nephrologists. Without clear coordination, opportunities to initiate kidney-protective therapies may be missed. Addressing these challenges will require both clinician education and health system strategies that support more consistent implementation of guideline-directed care.

Throughout the discussion, experts emphasized that improving CKD outcomes depends on identifying the disease earlier. Because CKD often progresses silently, many patients remain undiagnosed until kidney function has declined substantially.

Routine laboratory testing, including estimated glomerular filtration rate (eGFR) and urine albumin-to-creatinine ratio (UACR), can help clinicians identify patients earlier and assess risk more effectively. Early detection also allows for more aggressive management of underlying drivers such as diabetes and hypertension.

As therapeutic options expand, earlier diagnosis may play an increasingly important role in altering the long-term trajectory of kidney disease.

Looking ahead, participants agreed that improving outcomes will require a more integrated approach to CKD care. No single specialty can address the full complexity of cardio-kidney-metabolic disease alone.

Instead, effective management will depend on collaboration across primary care, cardiology, endocrinology, and nephrology to identify at-risk patients earlier, coordinate treatment strategies, and ensure consistent use of kidney-protective therapies.

The discussion ultimately highlighted a key inflection point for CKD care. Scientific advances have created new opportunities to slow disease progression and reduce complications, but realizing those benefits will require closing persistent gaps in awareness, screening, and treatment.

US Centers for Disease Control and Prevention. Chronic Kidney Disease in the United States, 2023. May 15, 2024. Accessed March 13, 2026. 

https://www.cdc.gov/kidney-disease/php/data-research/index.html

American Kidney Fund. Risk factors for kidney disease. Accessed March 13, 2026. 

https://www.kidneyfund.org/all-about-kidneys/risk-factors

Chronic kidney disease is increasingly conceptualized within a cardio-kidney-metabolic continuum, reflecting shared pathobiology with diabetes, hypertension, obesity, and cardiovascular disease. This framing expands accountability beyond nephrology and elevates the need for coordinated, multidisciplinary care. Multiple disease-modifying drug classes now show robust renal and cardiovascular risk reduction, prompting guideline support for earlier initiation, yet real-world uptake lags. Persistent underdiagnosis—driven by asymptomatic progression and inconsistent eGFR/UACR testing—limits timely intervention, underscoring implementation gaps in screening, education, and care integration.

New CKD therapies and a cardiometabolic care model are reshaping kidney disease management.

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Chronic Kidney Disease

Integrating Kidney Health Across the Cardio-Kidney-Metabolic Care Spectrum

Improving Patient Education and Pill Burden in Heart Failure Treatment, With Anuradha Lala, MD

Although the overall nature of addressing 

 in clinics has shifted to a more holistic approach, improvements can still be made to the patient’s side of treatment, including pill burden and patient education.

“Unfortunately, there’s a major gap between evidence and widespread, broad understanding,” Anuradha Lala, MD, professor of medicine, cardiology, and population health, director of the ACGME Fellowship in Advanced Heart Failure and Transplant, and Director of the Heart Failure Clinical Trials program at Mount Sinai Hospital, told 

 in an exclusive interview. “Despite patient behavior having an influence on outcomes, there are studies after studies that show that patients often leave a heart failure hospitalization without a clear understanding of what the disease is, why their medications matter, and what warning signs should prompt them to call us.”

HF is a product of several lifestyle factors including sleep, diet, exercise, and lipid levels. However, data from a past meta-analysis have shown that roughly 60% of premature deaths from HF could be attributed to unhealthy lifestyle factors. Additionally, roughly half of patients with HF do not follow recommended treatment procedures, limiting their chances of improvement.

Prior research has emphasized the importance of informing patients of the potential risks of HF and how to manage them in their everyday life. A study from 2021, during which a proportion of patients were given 4-step education sessions to address misconceptions and potential lifestyle improvements, indicated increased capacity for self-management of risk factors afterwards. Patients who received education on their condition were more open to clinician suggestions for management.

Another well-documented issue facing patients and clinicians alike is the pill burden present in HF treatment. The main medication cascade currently consists of 4 main drugs, known as the pillars of heart failure: angiotensin receptor-neprilysin inhibitors (ARNI), beta-blockers, mineralocorticoid receptor antagonists (MRA), and SGLT2 inhibitors. Standard GDMT recommends using all 4 treatments in every patient – given the sheer number of pills this requires, coupled with the disease’s implicit effects on quality of life, patients face a substantial burden simply from managing HF.

“The average patient with heart failure with reduced ejection fraction is taking somewhere between 6 and 10 meds when you account for all their comorbid conditions or other risk factors like 

, depression, et cetera,” Lala said. “And then the 4 pillar GDMT on top of that is not trivial.”

Despite these limitations, the ongoing shift towards a more multidisciplinary means of treatment – including nephrology and endocrinology, among other specialties – is an encouraging step towards better HF care. Chief among this movement is the cardio-kidney-metabolic framework put forth by the American Heart Association in 2023, highlighting the interplay between cardiovascular health and major comorbidities like 

“I think that adopting this cardio-kidney-metabolic framework really emphasizes the various aspects of the disease,” Lala said. “It’s about underlying inflammation, altered physiology and hormone health, coupled with poor diet, lack of exercise, and so on, that leads ultimately to the manifestations of heart disease, heart failure being one of its most prominent forms. I think us shifting to understand that we need to treat patients holistically and not in our silos of expertise is huge, and I pray that patients will stand to do better from our more holistic standards of care.”

Editors’ Note: Lala reports disclosures with Abiomed, AstraZeneca, Merck & Co., Novo Nordisk, Sequana, Bayer, and others.

1: Podvorica E, Bekteshi T, Oruqi M, Kalo I. Education of the Patients Living with Heart Disease. Mater Sociomed. 2021;33(1):10-15. 

2: Smith JL, Killian JM, Shippee N, et al. Burden of treatment in patients with heart failure. Journal of the American Heart Association. 

Lala discusses ongoing challenges in the HF treatment cascade, highlighting widespread misunderstandings among patients and the issue of extreme pill burden.

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