Closing Thoughts on CKD Management

EP: 1.Getting to Know CKD

EP: 2.Populations That Develop CKD

EP: 3.Unmet Needs in CKD Therapy

EP: 4.CKD Health Disparities and Their Consequences

EP: 5.Recognizing the Economic Burden of CKD

EP: 6.Acknowledging the Economic and Clinical Burdens of CKD and CVD

EP: 7.Screening for CKD

EP: 8.Preventing CKD Underdiagnosis

EP: 9.Treatment Goals for Patients With CKD

EP: 10.Blood Pressure Management Within the CKD Treatment Landscape

EP: 11.Treating CKD Using Multiple Methods

EP: 12.The Role of MRAs in CKD and CV Treatment

EP: 13.Using Published Data to Consider SGLT2 Inhibitors and MRAs in CKD Management

EP: 14.Combination Therapy and Payer Perspective on CKD Therapies

EP: 15.Continued Health Disparities Seen in Practice

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EP: 16.Closing Thoughts on CKD Management

Ryan Haumschild, PharmD, MS, MBA: Thank you all for this rich and informative discussion. Before we conclude, I’d like to get final thoughts from each of you. Let’s start with Dr Feldman. Leave us with some parting thoughts for our viewers based on this discussion.

Jeffrey Feldman, MD: I want to point out that we have to be more preventive in treating disease before it becomes chronic and progressive, with reference to diabetes and CKD [chronic kidney disease]. We haven’t talked about how there are now studies available, particularly SGLT2 studies, and Dr Agarwal said some studies are going to be done with MRAs [mineralocorticoid receptor antagonists], that CKD with or without diabetes can be treated, and [you can] slow the progression. When you slow the progression, you have fewer [poor] cardiovascular outcomes, including heart failure, which is No. 1, and patients feel better. Quality-of-life studies are on the horizon. The SGLT2 inhibitors all have [good] quality of life. People are doing better. When people are doing better, they’re happier and can enjoy their life, even though they have chronic kidney disease.

I’ll close with something I heard one day on the radio as I was coming home that made me smile. As the Beatles said, “Here comes the sun.” I’ll close with that. The new medications, new implementation, using social determinants of health, and using a team approach with the patient in the center will improve patient outcomes. I thank you all.

Ryan Haumschild, PharmD, MS, MBA: Thank you for that positive outlook. I’m excited about the future treatment landscape as well. Dr Agarwal, I’m curious about your final thoughts for our viewers.

Rajiv Agarwal, MD, MS: I’m going to make a remark that is probably important for every physician who is listening. It has to do with the social history that we take. When we ask our medical students to take a social history, you’ll hear about smoking, drugs, or alcohol, and that’s where it ends. We need to do a lot better. Every time I do rounds on patients or I see outpatients, I’m truly humbled how much social factors play an important role in the genesis, progression, and acute illnesses of the patients. If we don’t address them, we have simply put a Band-Aid on.

Social determinants of health has understandably become an important topic. It has become an important area of emphasis, including at Humana. Paul Sapia pointed out the initiatives, and I applaud them. But at an individual physician level, we have to do better. You need to find out how your patients live, where they live, and whether they have any activities going on. Do they have a pet? Do they take it for a walk? Or are they only watching television? I’ve visited homes of patients, and a simple 5-minute trip will tell me exactly how and why the patient got there because I know what they’re doing and where they’re living. We need to explore that much more when we see our patients on a day-to-day basis rather than leave it to the textbooks. That’s all.

Ryan Haumschild, PharmD, MS, MBA: Excellent thoughts. Thank you. Dr Pitt, what final thoughts do you have for us?

Bertram Pitt, MD: I’ve been around quite a while, and over my lifetime there has been dramatic change in how we treat heart failure and renal disease. We have tools now that we can move to prevention and even stop the progression and development of disease. But I’m also excited about the future. There are clues that we can make a big difference.

In the discussion, Dr Feldman alluded to inflammation and autoimmunity. There are new modalities that we can [use to] begin to attack this, which hasn’t been attacked. There are lots of things for the future. But most importantly, we have tools now that we have to learn how to use. Maybe there are things coming in the future—I think there are—but if we don’t use the tools we have right now, we’ve missed a tremendous opportunity. We have very potent tools, with the SGLT2 [inhibitors] and now the nonsteroidal MRAs, such as finerenone.

Ryan Haumschild, PharmD, MS, MBA: [We have] excellent new therapies. How can we make sure that we’re utilizing them and getting patient access? I’m going to have our valued managed care colleague, Paul, give our final thought from our panel.

Paul Sapia, MHA: We’ve all touched on the social determinants of health and understanding those zip code issues and community issues that exist. Dr Agarwal talked about going into the home and being able to see [their living situation]. Is there food in the home? Is it clean? Is the air conditioning working? Those are all important things. As we look at our clinician partners and our other types of provider partners who are going into the home to help people get things like food and nutrition, how do we get a lens into the patient’s home to understand?

The other part that I touched on earlier is the caregivers and family support. [In addition] to behavior change with the member, the family members and caregivers have to support that behavior change. It’s important to educate why we have to do this, why this is important, how to do it, and give them tools to be able to do it. If we look at prevention, we’ve got the data and analytics, and we understand what’s going on with community, so we could focus a lot of these efforts on the specific communities that have high incidences of diabetes, heart disease, and obesity, and start to change what’s going on within those zip codes and areas. Thank you very much. I appreciate being a part of the panel.

Ryan Haumschild, PharmD, MS, MBA: Thank you all, again. And thank you to our viewing audience. We hope you found this AJMC® Peer Exchange to be useful and informative.

Transcript edited for clarity.