Moving from Evidence to Implementation of Breakthrough Therapies for Diabetic Kidney Disease

Diabetic kidney disease (DKD) is the most frequent cause of kidney failure, accounting for half of all cases worldwide. Moreover, deaths from DKD increased 106% between 1990 and 2013 with most attributed to cardiovascular disease. Recommended screening and monitoring for DKD is conducted in less than half of patients with diabetes. Standard-of-care treatment with an angiotensin converting enzyme inhibitor or an angiotensin receptor blocker is correspondingly low. Sodium-glucose cotransporter 2 inhibitors, glucagon-like peptide-1 receptor agonists, and a non-steroidal mineralocorticoid antagonist are highly effective therapies to reduce kidney and cardiovascular risks in DKD. However, fewer than 20% of eligible patients are receiving these agents. Critical barriers are high out-of-pocket drug costs and low reimbursement rates. Data demonstrating clinical and cost effectiveness of DKD care are needed to garner payer and healthcare system support. The pharmaceutical industry should collaborate on value-based care by increasing access through affordable drug prices. Additionally, multidisciplinary models and communication technologies tailored to individual healthcare systems are needed to support optimal DKD care. Community outreach efforts are also central to make care accessible and equitable. Finally, it is imperative that patient preferences and priorities shape implementation strategies. Access to care and implementation of breakthrough therapies for DKD can save millions of lives by preventing kidney failure, cardiovascular events, and premature death. Coalitions comprised of patients, families and community groups, healthcare professionals, healthcare systems, federal agencies and payers are essential to develop collaborative models that successfully address this major public health challenge.