University of Manitoba’s Navdeep Tangri, MD, PhD, FRCP, discusses risk stratification in chronic kidney disease (CKD), innovations in the field, and how the interplay of population health strategies and policy reforms can benefit patient care. We will explore the theme of With the belief that CKD risk stratification can optimize the quality of care patients receive, Mr. Tangri shares his experience, insight into what works and what can be improved in these processes. are sharing.
This topic, among others, was explored at the Value-Based Medicine Institute’s event, “Optimizing Kidney Health: Advances in Proactive Care Models,” held in Park City, Utah, at the end of September.
This transcript has been lightly edited.
transcript
What are the most promising innovations in CKD risk stratification that could impact early detection, intervention efforts, and patient outcomes?
Innovations are occurring in both diagnosis and treatment, and risk stratification can help bridge the two. Diagnosis is currently focused on home testing. We have home testing kits and solutions, and there are companies working to make getting a diagnosis as easy as possible for patients. At the same time, we have four treatments available. Four highly effective treatments for diabetic nephropathy and several other treatments for IgA nephropathy and other glomerular diseases are coming to market. The biggest question on my mind is how to connect patients, some of whom currently screen positive and some of whom are high-risk patients, to appropriate treatment. That’s where risk stratification comes in, and highly accurate models now exist that can do just that. They can capture the data available at the time of screening to understand which of these patients are at high risk, which treatments may be beneficial, and establish connections that are often missed. can.
What role do social determinants of health play in CKD risk stratification? How can population health strategies better account for these factors in at-risk communities? Is it?
I believe that a population health approach is essential when tackling diseases like chronic kidney disease. Especially since we know that social determinants of health, difficult socio-economic status, and low economic status are drivers of chronic kidney disease. Screening in these high-risk communities is essential, but perhaps equally important is enabling access to treatment and providing some type of passive surveillance. Yes, there are issues with patients from marginalized communities not getting enough testing, but perhaps just as important, they are either not getting adequate care or are receiving some kind of disjointed care. That’s it. In my opinion, a population health approach that uses the laboratory as a safety net to discover high-risk disease and detect undertreated or untreated chronic kidney disease can help close this gap.
How can CKD risk stratification contribute to more efficient allocation of healthcare resources?
I believe that from 2002 to 2015, drug development for chronic kidney disease was in a “desert.” In fact, there have been no advances in treatment. And if you fast forward to the past 10 years, it’s actually been amazing. We have several highly effective treatments that slow the progression of kidney disease and prevent hospitalization for heart failure. So should all patients with chronic kidney disease receive all four pillars of care? I don’t think it’s cost-effective or practical in the real world. Therefore, health systems and payers need a way to allocate the intensity of treatment to patients who need it most, and risk stratification is the key to finding high-risk patients who require high-intensity treatment. You will play a role in helping with this.
What are the main barriers to implementing risk-based care models for CKD and how can policy makers and healthcare leaders work to overcome them?
I think the biggest barrier to implementing a comprehensive national health strategy for CKD is focusing too much on later stages. A few years ago, we finally shifted our focus from dialysis care to later stages of care, but we are still stuck in the EGFR (estimated glomerular filtration rate) or CKD stage model, and now stage 4 is It is attracting attention. The reality is that patients with high-risk, rapidly progressing heart failure events are spread across all stages of CKD, whereas pre-dialysis is the only stage of concern. So I think one of the big things that policymakers and payers need to get serious about is moving away from this EGFR-centric view. I think lab data will be very helpful in making this possible. We believe that by combining laboratory data and risk prediction models, we can find such patients, regardless of what stage of kidney disease they are in, and target them before they lose kidney function.
What is the most important takeaway you want your audience to take away from your presentation and work in this field?
First, I wanted to emphasize to the audience that CKD risk prediction has arrived. Here it is. It is accurate and practical. Currently, routinely available and regularly collected laboratory data can be used to identify patients who progress or develop heart failure. There is now an urgent need to act for these patients. Because if you act early, instead of waiting until stage 4 and then waiting until dialysis, you’ll miss the boat. And if we address them early, we can actually change that entire trajectory. It can prevent lifelong dialysis. So I delivered an optimistic message, that high-risk diseases should be treated with high-intensity therapy, which could be transformative for patients.
