Устранение пробелов в лечении почек: воплощение того, что мы знаем, в то, что мы делаем

Исторически сложилось так, что на процесс перехода новых методов лечения из области клинических доказательств в повседневную практику уходит в среднем 17 лет. Учитывая существование в настоящее время высокоэффективных методов лечения, позволяющих предотвратить или отсрочить развитие и прогрессирование заболеваний почек, это слишком долгий срок. Настало время сократить разрыв между тем, что мы знаем, и тем, что мы делаем. Существуют четкие рекомендации по профилактике и управлению распространенными факторами риска развития заболеваний почек, такими как гипертония и диабет, но во всем мире лишь у части людей с этими заболеваниями установлен диагноз, а еще меньше – получают целевое лечение. Аналогичным образом подавляющее большинство людей, живущих с заболеваниями почек, не знают о своем состоянии, поскольку на ранних стадиях оно часто протекает бессимптомно. И даже среди пациентов, которым диагноз был установлен, многие не получают надлежащего лечения по поводу болезни почек. Учитывая серьезные последствия прогрессирования болезни почек – утрату функции почек или смерть, – крайне важно начать лечение на ранних стадиях и должным образом. Возможности ранней диагностики и лечения заболеваний почек должны быть максимально расширены, начинаясь с уровня первичной медицинской помощи. Существуют множество систематических препятствий, начиная с самих пациентов и врачей и заканчивая уровнем системы здравоохранения и общественными факторами. Для сохранения и улучшения здоровья почек всех и каждого необходимо признать существование каждого из этих барьеров, чтобы разработать устойчивые решения и внедрять их без дальнейших задержек.

1. Jager KJ, Kovesdy С, Langham R et al. A single number for advocacy and communication-worldwide more than 850 million individuals have kidney diseases. Kidney Int 96 (2019):1048–1050

2. Institute for Health Metrics and Evaluation (IHME). GBD compare data visualization. Accessed November 18, 2023. http://vizhub.healthdata.org/gbd-compare

3. Luyckx VA, Tonelli M, Stanifer JW. The global burden of kidney disease and the sustainable development goals. Bull World Health Organ 96 (2018): 414–422D

4. International Society of Nephrology. ISN Global Kidney Health Atlas, 3rd ed. Accessed November 18, 2023. https://www.theisn.org/initiatives/global-kidney-health-atlas/

5. GBD Chronic Kidney Disease Collaboration. Global, regional, and national burden of chronic kidney disease, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet 395 (2020) 709–733

6. Vanholder R, Annemans L, Brown E et al. Reducing the costs of chronic kidney disease while delivering quality health care: a call to action. Nat Rev Nephrol 13 (2017) 393–409

7. Nguyen-Thi HY, Le-Phuoc TN, Tri Phat N et al. The economic burden of chronic kidney disease in Vietnam. Health Serv Insights 14, 2021

8. US Renal Data System. Healthcare expenditures for persons with CKD. https://usrds-adr.niddk.nih.gov/2023/chronickidney-disease/6-healthcare-expenditures-for-persons-with-ckd

9. Kidney Health Australia. Transforming Australia’s kidney health: a call to action for early detection and treatment of chronic kidney disease. Accessed January 16, 2024. https://kidney.org.au/uploads/resources/Changing-the-CKD-landscape-Economicbenefits-of-early-detection-and-treatment.pdf

10. Ke C, Liang J, Liu M et al. Burden of chronic kidney disease and its risk-attributable burden in 137 low-and middle-income countries, 1990-2019: results from the global burden of disease study 2019. BMC Nephrol 23 (2022):17

11. Gregg EW , Buckley J, Ali MK et al. Improving health outcomes of people with diabetes: target setting for the WHO Global Diabetes Compact. Lancet 401 (2023): 1302–1312

12. Geldsetzer P, Manne-Goehler J, Marcus ME et al. The state of hypertension care in 44 low-income and middle-income countries: a cross-sectional study of nationally representative individual-level data from 1.1 million adults. Lancet 394 (2019): 652–662

13. Chu L, Bhogal SK, Lin P et al. AWAREness of Diagnosis and Treatment of Chronic Kidney Disease in Adults With Type 2 Diabetes (AWARE-CKD in T2D). Can J Diabetes 46 (2022): 464–472

14. Levin A, Tonelli M, Bonventre J et al. Global kidney health 2017 and beyond: a roadmap for closing gaps in care, research, and policy. Lancet 390 (2017):1888–1917

15. Stengel B, Muenz D, Tu C et al. Adherence to the Kidney Disease: Improving Global Outcomes CKD guideline in nephrology practice across countries. Kidney Int Rep 6 (2021): 437–448

16. Chu CD, Chen MH, McCulloch CE et al. Patient awareness of CKD: a systematic review and meta-analysis of patient-oriented questions and study setting. Kidney Med 3 (2021): 576–585.e1

17. Ene-Iordache B, Perico N, Bikbov B et al. Chronic kidney disease and cardiovascular risk in six regions of the world (ISNKDDC): a cross-sectional study. Lancet Global Health 4 (2016): e307–e319

18. Gummidi B, John O, Ghosh A et al. A systematic study of the prevalence and risk factors of CKD in Uddanam, India. Kidney Int Rep 5 (2020): 2246–2255

19. Kidney Disease: Improving Global Outcomes (KDIGO) Diabetes Work Group. KDIGO 2022 Clinical Practice Guideline for Diabetes Management in Chronic Kidney Disease. Kidney Int 102 (5S) (2022): S1–S127

20. Nicho las SB, Daratha KB, Alicic RZ et al. Prescription of guideline-directed medical therapies in patients with diabetes and chronic kidney disease from the CURE-CKD Registry, 2019–2020. Diabetes Obes Metab 25 (2023): 2970–2979

21. Grams ME, Yang W, Rebholz CM et al. Risks of adverse events in advanced CKD: the Chronic Renal Insufficiency Cohort (CRIC) study. Am J Kidney Dis 70 (2017): 337–346

22. Kidney Disease: Improving Global Outcomes (KDIGO) CKD Work Group. KDIGO 2024 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease. Kidney Int. https://doi.org/10.1016/j.kint.2023.10.018

23. Kidney Disease: Improving Global Outcomes (KDIGO) Blood Pressure Work Group. KDIGO 2021 clinical practice guideline for the management of blood pressure in chronic kidney disease. Kidney Int 99 (3S) (2021): S1–S87

24. Tuttle KR, Alicic R Z, Duru OK et al. Clinical characteristics of and risk factors for chronic kidney disease among adults and children: an analysis of the CURE-CKD registry. JAMA Netw Open 2, 2019

25. Ismail WW, Witry MJ, Urmie JM. The association between cost sharing, prior authorization, and specialty drug utilization: a systematic review. J Manag Care Spec Pharm 29 (2023): 449–463

26. Heerspink HJL, Vart P, Jongs N et al. Estimated lifetime benefit of novel pharmacological therapies in patients with type 2 diabetes and chronic kidney disease: a joint analysis of randomized controlled clinical trials. Diabetes Obes Metab 25 (2023): 3327–3336

27. Nuffield Department of Population Health Renal Studies Group. SGLT2 Inhibitor Meta-Analysis Cardio-Renal Trialists' Consortium. Impact of diabetes on the effects of sodium glucose co-transporter-2 inhibitors on kidney outcomes: collaborative meta-analysis of large placebo-controlled trials. Lancet 400 (2022):1788–1801

28. Fernández-Fernandez B, Sarafidis P, Soler MJ et al. EMPA-KIDNEY: expanding the range of kidney protection by SGLT2 inhibitors. Clin Kidney J 16 (2023):1187–1198

29. McEwan P, Boyce R, Sanchez JJG et al. Extrapolated longer-term effects of the DAPA-CKD trial: a modelling analysis. Nephrol Dial Transplant 38 (2023): 1260–1270

30. Vanholder R, Annemans L, Braks M et al. Inequities in kidney health and kidney care. Nat Rev Nephrol 19 (2023): 694–708

31. Agarwal R, Filippatos G, Pitt B et al. Cardiovascular and kidney outcomes with finerenone in patients with type 2 diabetes and chronic kidney disease: the FIDELITY pooled analysis. Eur Heart J 43 (2022): 474–484

32. Tuttle KR, Bosch-Traberg H, Cherney DZI et al. Post hoc analysis of SUSTAIN 6 and PIONEER 6 trials suggests that people with type 2 diabetes at high cardiovascular risk treated with semaglutide experience more stable kidney function compared with placebo. Kidney Int 103 (2023): 772–781

33. Rubin R. It takes an average of 17 years for evidence to change practice-the burgeoning field of implementation science seeks to speed things up. JAMA 329 (2023): 1333–1336

34. World Health Organisation. Mid-point evaluation of the implementation of the WHO global action plan for the prevention and control of noncommunicable diseases 2013–2020 (NCDGAP). Accessed November 18, 2023. https://cdn.who.int/media/docs/default-source/documents/about-us/evaluation/ncd-gapfinal-report.pdf?sfvrsn=55b22b89_5&download=true

35. Kruk ME, Gage AD, Joseph NT et al. Mortality due to low-quality health systems in the universal health coverage era: a systematic analysis of amenable deaths in 137 countries. Lancet 392 (2018): 2203–2212

36. Kingori P, Peeters Grietens K, Abimbola S. et al. Uncertainties about the quality of medical products globally: lessons from multidisciplinary research. BMJ Glob Health 6, 2023

37. Pan American Health Organization Quality control of medicines. Accessed November 18, 2023. https://www.paho.org/en/topics/quality-control-medicines

38. Tuttle KR, Wong L, St Peter W et al. Moving from evidence to implementation of breakthrough therapies for diabetic kidney disease. Clin J Am Soc Nephrol 17 (2022): 1092–1103

39. Kalyesubula R, Conroy AL, Calice-Silva V et al. Screening for kidney disease in low- and middle-income countries. Semin Nephrol 42, 2022

40. Francis A, Abdul Hafidz MI, Ekrikpo UE et al. Barriers to accessing essential medicines for kidney disease in low- and lower middle-income countries. Kidney Int 102 (2022): 969–973

41. Rangaswami J, Tuttle K, Vaduganathan M . Cardio-renal-metabolic care models: toward achieving effective interdisciplinary care. Circ Cardiovasc Qual Outcomes 13, 2020

42. Neumiller JJ, Alicic RZ, Tuttle KR. Overcoming barriers to implementing new therapies for diabetic kidney disease: lessons learned. Adv Chronic Kidney Dis 28 (2021): 318–327

43. Mishra SR, Neupane D, Preen D et al. Mitigation of non-communicable diseases in developing countries with community health workers. Global Health 11 (2015): 43

44. Joshi R, John O, Jha V. The potential impact of public health interventions in preventing kidney disease. Semin Nephrol 37 (2017): 234–244

45. Patel A, Praveen D, Maharani A et al. Association of multi-faceted mobile technology-enabled primary care intervention with cardiovascular disease risk management in rural Indonesia. JAMA Cardiol 4 (2019): 978–986

46. Ardavani A, Curtis F, Khunti K et al. The effect of pharmacist-led interventions on the management and outcomes in chronic kidney disease (CKD): a systematic review and meta-analysis protocol. Health Sci Rep 6, 2023

47. Sherrod CF, Farr SL, Sauer AJ. Overcoming treatment inertia for patients with heart failure: how do we build systems that move us from rest to motion? Eur Heart J 44 (2023): 1970–1972

48. Ramakrishnan C, Tan NC, Yoon S et al. Healthcare professionals' perspectives on facilitators of and barriers to CKD management in primary care: a qualitative study in Singapore clinics. BMC Health Services Res 22 (2022): 560

49. Porter J, Boyd C, Skandari MR et al. Revisiting the time needed to provide adult primary care. J Gen Intern Med 38 (2023): 147–155

50. Peralta CA, Livaudais-Toman J, Stebbins M et al. Electronic decision support for management of CKD in primary care: a pragmatic randomized trial. Am J Kidney Dis 76 (2020): 636–644

51. Rios P, Sola L, Ferreiro A et al. Adherence to multidisciplinary care in a prospective chronic kidney disease cohort is associated with better outcomes. PLoS One 17, 2022

52. Stevenson JK, Campbell ZC, Webster AC et al. eHealth interventions for people with chronic kidney disease. Cochrane Database Syst Rev 8 (2019): Cd012379

53. Tuot DS, Crowley ST, Katz LA et al. Usability testing of the kidney score platform to enhance communication about kidney disease in primary care settings: qualitative think-aloud study. JMIR Form Res 6, 2022

54. Verberne WR, Stiggelbout AM, Bos WJW et al. Asking the right questions: towards a person-centered conception of shared decision-making regarding treatment of advanced chronic kidney disease in older patients. BMC Med Ethics 23 (2022): 47

55. Taha A, Iman Y, Hingwala J et al. Patient navigators for CKD and kidney failure: a systematic review. Kidney Med 4, 2022

56. Essue BM, Laba M, Knaul F et al. Economic burden of chronic ill health and injuries for households in low- and middle-income countries. in: DT Jamison, H Gelband, S Hortonet al. (Eds.), Disease Control Priorities: Improving Health and Reducing Poverty. 3rd ed. The International Bank for Reconstruction and Development/The World Bank; 2017. https://doi.org/10.1596/978-14648-0527-1_ch6

57. Khatib R, McKee M, Shannon H et al. Availability and affordability of cardiovascular disease medicines and their effect on use in high-income, middle-income, and low-income countries: an analysis of the PURE study data. Lancet 387 (2016): 61–69

58. Kamath N, Iyengar AA. Chronic kidney disease (CKD): an observational study of etiology, severity and burden of comorbidities. Indian J Pediatr 84 (2017): 822–825

59. Cirillo L, Ravaglia F, Errichiello C et al. Expectations in children with glomerular diseases from SGLT2 inhibitors. Pediatr Nephrol 37 (2022): 2997–3008

60. Donohue JF, Elborn JS, Lansberg P et al. Bridging the «know-do» gaps in five non-communicable diseases using a common framework driven by implementation science. J Healthc Leadersh 15 (2023):103–119

61. Population Health Research Institute. Polypills added to WHO essential medicines list. Accessed November 18, 2023. https://www.phri.ca/eml/

62. Sepanlou SG, Mann JFE, Joseph P et al. Fixed-dose combination therapy for prevention of cardiovascular diseases in CKD: an individual participant data meta-analysis. Clin J Am Soc Nephrol 18 (2023): 1408–1415

63. Dev V, Mittal A, Joshi V et al. Cost analysis of telemedicine use in paediatric nephrology-the LMIC perspective. Pediatr Nephrol 39 (2024): 193–201

64. Musacchio N, Zilich R, Ponzani P et al. Transparent machine learning suggests a key driver in the decision to start insulin therapy in individuals with type 2 diabetes. J Diabetes 15 (2023): 224–236

65. Zuniga C, Riquelme C, Muller H et al. Using telenephrology to improve access to nephrologist and global kidney management of CKD primary care patients. Kidney Int Rep 5 (2020): 920–923

66. van der Horst DEM, Hofstra N, van Uden-Kraan CF et al. Shared decision making in health care visits for CKD: patients' decisional role preferences and experiences. Am J Kidney Dis 82 (2023): 677–686

67. Hole B, Scanlon M, Tomson C. Shared decision making: a personal view from two kidney doctors and a patient. Clin Kidney J 16 (2023): i12–i19