Dr. Navdeep Tangri of the University of Manitoba emphasizes the transformative potential of combining advanced risk stratification with population health strategies to revolutionize chronic kidney disease (CKD) care management. This innovative approach promises to bridge critical gaps in patient care while optimizing resource allocation.
Bridging Diagnostics and Treatment Through Innovation
The CKD care landscape is experiencing unprecedented advancement in both diagnostics and therapeutics. Home testing solutions are making disease detection more accessible, while four highly effective therapies for diabetic kidney disease and various treatments for conditions like IgA nephropathy are entering the market.
"The biggest issue in my mind is: how do you connect the patients—the patients who have now screened positive, and some of them who are high risk—to the right treatment?" Dr. Tangri explains. Modern risk stratification models address this challenge by analyzing screening data to identify high-risk patients and determine optimal therapeutic approaches.
Population Health Strategies: Addressing Social Determinants
Social determinants of health significantly impact CKD outcomes, particularly in communities with lower socioeconomic status. Population health approaches have emerged as essential tools for addressing these disparities. Dr. Tangri advocates for using laboratory data as a safety net to identify and monitor high-risk cases, especially in marginalized communities where disconnected care is common.
Resource Allocation and Treatment Intensity
The past decade has witnessed remarkable therapeutic advances in CKD treatment, with multiple effective interventions now available. However, Dr. Tangri notes that applying all available treatments to every patient is neither cost-effective nor practical. Risk stratification plays a crucial role in matching treatment intensity to patient need, ensuring optimal resource allocation.
Moving Beyond Traditional Stage-Based Approaches
A significant barrier to implementing comprehensive population health strategies has been the excessive focus on later CKD stages and EGFR-centered models. Dr. Tangri challenges this approach, noting that high-risk patients and rapid progressors exist across all CKD stages.
"We need to get away from this EGFR-centered view," he emphasizes. "Lab data, combined with risk-prediction models, can find those patients, no matter what stage of kidney disease they're in, and target them before they lose their kidney function."
Early Intervention: A Message of Optimism
Dr. Tangri delivers an optimistic message about the future of CKD care. With accurate and actionable risk prediction tools now available, healthcare providers can identify patients at risk of progression and heart failure events using routine laboratory data. Early intervention with high-intensity therapy can fundamentally alter disease trajectories and potentially prevent lifetime dialysis dependency.
"If we act on them early, we can actually change their entire trajectory," Dr. Tangri concludes. "We can prevent a lifetime of dialysis."
