Closing Screening Gaps for Cardio-Kidney-Metabolic Disease

"Closing Screening Gaps for Cardio-Kidney-Metabolic Disease" explores why a large population of at-risk patients remains undiagnosed despite frequent contact with the health system.

Dr. Vaduganathan turns to the scale of the undiagnosed cardio-kidney-metabolic population and why so many at-risk patients are missed. He describes a large group of patients in the community who have already interacted with the health system, meeting a cardiologist for early heart failure concerns, a nephrologist for chronic kidney disease, or an endocrinologist for type 2 diabetes, yet still fall through the cracks. The reason, he argues, is that clinicians across these specialties have practiced in relative silos, each focused on their own condition without routinely screening for the adjacent cardio-kidney-metabolic conditions a patient may also carry. That gap, he says, represents a significant missed opportunity to build a more holistic picture of an individual's overall risk trajectory.

Dr. Vaduganathan traces the underdiagnosis partly to misaligned incentives. Additional testing adds time to a clinic visit, requires explaining results to patients, and demands a follow-up workflow for any abnormal findings, infrastructure that many current care systems simply do not have in place. He suggests payers have a substantial role to play here, potentially incentivizing the upfront screening that specialists are otherwise disincentivized to pursue given time and workflow constraints.

He closes by emphasizing the downstream value of catching these conditions earlier. If proven, evidence-based therapies can be started before complications accrue, and before costly events like hospitalizations occur, Dr. Vaduganathan believes clinicians can meaningfully change a patient's risk trajectory. Earlier identification, in his view, is not just a diagnostic nicety but a direct lever for avoiding the downstream costs that both patients and payers ultimately bear when cardio-kidney-metabolic disease goes unrecognized until it is advanced.

The final episode, "SGLT2 Inhibitors: Practical Guidance for Clinicians and Formularies," closes the series with Dr. Vaduganathan's practical guidance for clinicians and formulary committees.