Advancing CKD and Cardiovascular Risk Management Through Diagnostic Testing - Episode 9
Unmet Needs Remaining in CKD Diagnosis
Clinicians rethink cardio-renal care: educate teams, streamline workflows, expand screening via pharmacists and EHRs, and prioritize prevention over dialysis.
In ‘Unmet Needs Remaining in CKD Diagnosis,’ our experts delve into the following critical question:
- What unmet needs remain in CKD diagnosis and testing despite current biomarker availability?
Led by the moderator, this discussion centers on the "sobering" disparity between clinical evidence and real-world practice, where screening rates for high-risk hypertensive and diabetic patients remain alarmingly low. Dr. Desai emphasizes that the primary unmet need is a massive educational shift to turn guideline "aspiration" into immediate clinical action. To solve access issues and social determinants of health, the experts suggest "outside-the-box" strategies, such as empowering pharmacists to conduct uACR testing and leveraging EHR population health tools to "nudge" clinicians toward missing screenings.
The panel also emphasizes the importance of treating the "complete person" through the CRM framework, suggesting that if primary care is too overburdened to manage complex protocols, dedicated CRM clinics should lead the initiation of guideline-directed medical therapy. Dr. Kushner notes that this proactive approach must include more aggressive targets, such as a systolic blood pressure of 120 mmHg for those with kidney disease, to protect the systemic endothelial lining. Ultimately, the speakers argue that the U.S. healthcare system should shift its focus from being a provider of end-of-life dialysis to becoming a global model for preventive therapy and renal preservation.
Our next episode, ‘Guiding CKD Treatment Decisions with uACR and eGFR Trends,’ further explores chronic kidney disease, focusing on optimizing the timing of nephrology referrals using the KDIGO heat map to distinguish between patients who can be managed within a cardiorenal metabolic framework and those requiring specialist intervention. The experts emphasize that while primary care and cardiology should lead early intervention to preserve renal function, nephrologists are essential when patients reach high-risk "orange and red" zones or present with "red flag" symptoms like rapidly progressive decline or nephrotic-range proteinuria.
