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Key Considerations for Future CKD Treatment Approach


Expert panelists share final points of emphasis regarding treatment for CKD.

Ryan Haumschild, PharmD, MS, MBA: Dr Nicholas, we’ve talked a lot about halting progression. What more can we do to delay the progression of CKD [chronic kidney disease]? Is it really centered around awareness? Is it getting the right therapeutic plan together? What efforts have been made to reduce the incidence and the overall effect of renal dysfunction or chronic kidney disease across the population?

Susanne B. Nicholas, MD, MPH, PhD: Great question. Getting close to the end to sort of tie this up. We’ve mentioned many things that are being done, have been done, but there are still things that can be done. We certainly [must] continue to focus on education and awareness with the patient as well as the provider level in terms of accessibility of the new medical therapies, particularly for vulnerable patients. But what about the new information that we’re gaining around chronic kidney disease, some of which we haven’t talked about?… For example, we know…about acute kidney injury being a risk factor for chronic kidney disease. It’s going to be important for us to pay attention, to diagnose AKI, acute kidney injury, and to manage it early on. That’s one. Another thing that’s fairly new, it’s using artificial intelligence simulation modeling and machine learning to identify models that can specifically say for a patient, these are the potentially modifiable risk factors for this patient. Based on data such as what we’re using for our chronic kidney disease registry from a large cohort of patients, we can identify specific modifiable risk factors then that could lead us to precision medicine. The last thing I would say is we know what we need to do to prevent CKD progression. What we haven’t focused on is actual prevention of chronic kidney disease. That should be our next focus.

Ryan Haumschild, PharmD, MS, MBA: Thank you. Well, we’ve had a lot of discussion throughout the day today. Thank you so much. I would say the biggest takeaway is we’ve got an exciting future ahead. How do we better screen patients earlier [in] diagnosis? More multidisciplinary collaboration and leveraging some of these new therapeutics that are really going to drive change in these patients’ lives? I want to thank you all again for this rich and informative discussion. But before we conclude, I do want to get final thoughts from each of you. If we could, Dr Anderson, can we start with you? What are your final thoughts for the viewing audience?

John E. Anderson, MD: I started practice and my diabetic available therapies were glipizide, glyburide.… It’s nearing the end of 2023, and it is astounding the therapies we have, not just for glycemic lowering but for treatment of all kinds of comorbidities and people with type 2 diabetes, including CKD, obesity, cardiovascular risk reduction, heart failure, risk reduction, the ability to now screen and hopefully intervene early in preventing the progression of CKD. But none of it makes any difference. It is not getting in the patient’s hands.

Ryan Haumschild, PharmD, MS, MBA:Those are really, really great thoughts. I agree. At the end of the day, the patient’s got to have the medication, take the medication to get that true benefit. Great comments. Dr Cohen, final thoughts from you?

Ken Cohen, MD: I think two important ones. One is that we need to shift our focus away from the responsibility of every provider doing everything right, because frankly, it’s a daunting task, and build systems that will aid them through clinical decision support, through case management, through population health management, software platforms to really make the job easier. I think ultimately more patients will get the therapies that they need. The second is that we now have very large data sets that we can utilize to answer some of the questions that our RCTs [randomized controlled trials] can’t or won’t answer and the ability to take these data sets—we have 154 million patients, for example, in a single data warehouse, and we can do synthetic RCTs now that get very close to mirroring what a true RCT would offer to answer questions that aren’t being done through RCTs. I think there’s a lot to be learned through that approach.

Ryan Haumschild, PharmD, MS, MBA: I love leveraging real-world evidence and data aggregators because sometimes what happens in a perfect world of a clinical trial with the research coordinator doesn’t always translate to the real world when that patient’s on the medication. I think those are really great thoughts. Dr Green, final thoughts from you?

Jennifer B. Green, MD: Well, my final thoughts are very similar to Dr Anderson’s, but I’d like to echo the tremendous strides that have been made in improving the health and outcomes of people with these chronic medical conditions. I personally find it to be a very exciting time to be involved in the care of people with diabetes and kidney disease. Who knew? When I was a fellow, the treatment options were so limited. I could never have envisioned what I would have to offer to people in the present day. I think it’s very important that we feel that excitement, that we translate that to our patients so that they understand why they’re doing what they’re doing and they continue to do it. We also need to make sure that we spread that excitement and knowledge to our colleagues so that everyone’s on the same page.

Ryan Haumschild, PharmD, MS, MBA: Excellent. You all have done a wonderful job educating your colleagues in the viewing audience. Dr Nicholas, I’d like you to round us out today with your thoughts.

Susanne B. Nicholas, MD, MPH, PhD: I would add, on top of everything that has already been said today, that we really need to continue to focus on education and awareness. It’s fundamental. We need to focus on things that we haven’t been paying as much attention to in the past, social determinants of health. We need to focus on preventing chronic kidney disease. Looking at other risk factors like obesity that was touched on earlier as a risk factor for diabetes and subsequently for chronic kidney disease. There’s still much for us to do. We’re getting there. We’re getting really close.

Ryan Haumschild, PharmD, MS, MBA: Well, thank you again. To our viewing audience, we hope you found this AJMC Stakeholder Summit to be useful and informative.

Transcript is AI-generated and edited for clarity and readability.

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