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Dr Daniel Weiner: We Need to Better Prioritize Early Detection, Preventive Care for DKD

While there are a number of treatments available for diabetic kidney disease (DKD), the biggest limitation is the lack of early detection, said Daniel E. Weiner, MD, MS, board certified nephrologist and lead navigator at Tufts Clinical and Translational Science Institute.

"None of the systems that are in place right now are designed to detect early stage kidney disease and prevent something from happening 5, 10, 20 years down the road," said Daniel E. Weiner, MD, MS, board certified nephrologist and lead navigator at Tufts Clinical and Translational Science Institute.

Transcript

How do current payment models fare in managing the care needs of patients with diabetic kidney disease, and what room for improvement do you see here? 

When it comes to diabetic kidney disease, diabetes is the most common cause of chronic kidney disease. And just like most other types of kidney disease, it's a very chronic course. It can be relatively slowly progressive, although it can advance in fits and starts, and it is a disease that truly benefits from earlier recognition.

We're at a stage right now where we actually have some fantastic kidney treatments for people with diabetic kidney disease. You have SGLT2 inhibitors, you have nonsteroidal mineralocorticoid receptor agonists, you still have your ACE inhibitors and ARBs in general blood pressure control and glycemic control, so there are a lot of things that we can do.

The limitation, again just like we're seeing throughout the chronic kidney disease space, is that these interventions have the greatest net effect if they're applied earlier. So our biggest limitation actually is a failure to detect kidney disease early on, even in people with diabetes who were universally recommended for screening, but also in people who have high blood pressure, people who have obesity, or even just about anybody because the prevalence of kidney disease is so high.

None of the systems that are in place right now are designed to detect early stage kidney disease and prevent something from happening 5, 10, 20 years down the road. I think that where we have the greatest need is in designing systems that are going to reward foresight and are going to reward true preventative care that's preventing something in the long-term, and educating patients and care partners and clinicians that we actually do have things in our armamentarium that can have benefits 2, 5, 10, 20 years down the road.

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