Closing the gap between evidence and practice in chronic kidney disease

Abstract

There are major gaps between our growing knowledge of effective treatments for chronic kidney disease (CKD), and the delivery of evidence-based therapies to populations around the world. Although there remains a need for new, effective therapies, current evidence suggests that many patients with CKD are yet to fully realize the benefits of blood pressure-lowering drugs (with and without reducing proteinuria with renin-angiotensin system blockade), wider use of statins to reduce atherosclerotic cardiovascular disease events, and better glycemic control in both type 1 and type 2 diabetes. There are many barriers to optimizing evidence-based nephrology care around the world, including access to health care, affordability of treatments, consumer attitudes and circumstances, the dissemination of appropriate knowledge, the availability of expertise and structural impediments in the delivery of health care. Further investment in implementation science that addresses the major barriers to effective care in a cost-effective manner could yield both local and global benefits.

Keywords: chronic kidney disease; implementation; treatment gap.

Figure 1

Availability of renal replacement therapy according to the country.

Figure 2

Increase in utilization of guideline-recommended therapies in an implementation project: the Atrial Fibrillation registry. Use of guideline-recommended therapies at baseline, 12 months, and 24 months in the longitudinal cohort. ACEI, angiotensin-converting enzyme inhibitor; ARB, angiotensin receptor blocker, CRT, cardiac resynchronization therapy; CRT-P, CRT with pacemaker; CRT-D, CRT with defibrillator; HF, heart failure. *P < 0.001, 12 and 24 months versus baseline. ^†P < 0.001, 12 versus 24 months. ^‡P = 0.007, 12 versus 24 months. ^§P = 0.009, 12 versus 24 months.