Best-Practice Perspectives on Improving Early Detection and Management of Chronic Kidney Disease Associated With Type 2 Diabetes in Primary Care

Abstract

Chronic kidney disease (CKD) is a progressive disease that can lead to kidney failure and increases the risk of cardiovascular disease (CVD), cardiovascular mortality, and all-cause mortality (1,2).Diabetes is a major risk factor for developing CKD (3) and CVD independent of CKD ( 4).Approximately 37 million people in the United States have CKD, and most (90%) are unaware they have the condition, so their CKD remains undiagnosed in primary care (3).Although treatment guidelines recommend screening at least annually for CKD in people with type 2 diabetes (5-7), uptake of screening for CKD in adults with diabetes remains low in routine clinical care (8).In the United States, prescription rates of guideline-recommended medications that have been shown to prevent CKD progression in people with CKD associated with type 2 diabetes also remain low (9,10).Most patients with risk factors for CKD are managed in primary care (11); therefore, primary care providers (PCPs) play an important role in the early detection of CKD.Targeted screening and early initiation of guideline-recommended treatments by PCPs is important to slow CKD progression and the development of comorbidities such as CVD.This fact underscores the need to support and facilitate awareness among PCPs to improve current screening, diagnosis, and treatment of CKD in primary care, especially if clinical evidence suggests that patients may benefit from an alternative approach.In this review, we give our perspectives and views on three important issues: 1) how adoption of screening across primary care could be improved, 2) why medications for CKD associated with type 2 diabetes are under-prescribed in primary care and how this could be improved, and 3) the possibility that a lack of awareness by nonspecialist PCPs of the clinical trial data supporting guideline recommendations for the treatment of CKD and type 2 diabetes is a barrier in primary care.To address the third issue, we have developed plain-language visual representations summarizing how these clinical data relate to the guideline recommendations, which are available in Supplementary Material, along with a plain-language summary of this article.

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