PDF(Pubmed)
Abstract：
For the first time in many years, guideline-directed drug therapies have emerged that offer substantial cardiorenal benefits, improved quality of life and longevity in patients with chronic kidney disease (CKD) and type 2 diabetes. These treatment options include sodium-glucose cotransporter-2 inhibitors, nonsteroidal mineralocorticoid receptor antagonists and glucagon-like peptide-1 receptor agonists. However, despite compelling evidence from multiple clinical trials, their uptake has been slow in routine clinical practice, reminiscent of the historical evolution of angiotensin-converting enzyme inhibitor and angiotensin II receptor blocker use. The delay in implementation of these evidence-based therapies highlights the many challenges to optimal CKD care, including: (i) clinical inertia; (ii) low CKD awareness; (iii) suboptimal kidney disease education among patients and providers; (iv) lack of patient and community engagement; (v) multimorbidity and polypharmacy; (vi) challenges in the primary care setting; (vii) fragmented CKD care; (viii) disparities in underserved populations; (ix) lack of public policy focused on health equity; and (x) high drug prices. These barriers to optimal cardiorenal outcomes can be ameliorated by a multifaceted approach, using the Chronic Care Model framework, to include patient and provider education, patient self-management programs, shared decision making, electronic clinical decision support tools, quality improvement initiatives, clear practice guidelines, multidisciplinary and collaborative care, provider accountability, and robust health information technology. It is incumbent on the global kidney community to take on a multidimensional perspective of CKD care by addressing patient-, community-, provider-, healthcare system- and policy-level barriers.
摘要：
多年来第一次，指南指导的药物治疗已经出现，提供了大量的心肾益处，改善慢性肾脏病（CKD）和2型糖尿病患者的生活质量和寿命。这些治疗方案包括钠-葡萄糖协同转运蛋白-2抑制剂，非甾体盐皮质激素受体拮抗剂和胰高血糖素样肽-1受体激动剂。然而,尽管多项临床试验提供了令人信服的证据,它们在常规临床实践中的吸收很慢，让人想起血管紧张素转换酶抑制剂和血管紧张素II受体阻滞剂使用的历史演变。这些循证疗法的实施延迟凸显了最佳CKD护理的许多挑战。包括：（i）临床惯性；（ii）CKD意识低；（iii）患者和提供者对肾脏疾病的教育欠佳；（iv）缺乏患者和社区参与；（v）多发病率和多药房；（vi）初级保健环境中的挑战；（vii）CKD护理分散；（viii）服务不足的人群中的差异；（ix）缺乏关注健康公平的公共政策；（x）药品价格高。这些障碍可以通过多方面的方法来改善最佳的心肾结果，使用慢性护理模式框架，包括患者和提供者的教育，病人自我管理计划，共同决策，电子临床决策支持工具，质量改进举措，明确的实践准则，多学科和协作护理，提供者问责制，和强大的健康信息技术。全球肾脏病界有责任通过解决患者来承担CKD护理的多维视角-，社区-,提供者-,医疗保健系统和政策层面的障碍。
