Pharmacists are central to optimizing chronic kidney disease (CKD) diagnosis and monitoring long-term adherence to disease-modifying therapies.
In an interview with Pharmacy Times, Muthiah Vaduganathan, MD, MPH, codirector of the Center for Cardiometabolic Implementation at Brigham and Women's Hospital, emphasized that chronic kidney disease (CKD) remains substantially underdiagnosed and undertreated in the United States and globally.
Vaduganathan highlighted persistent gaps in both early detection and patient awareness, noting that foundational diagnostic tests—estimated glomerular filtration rate (eGFR) and urine albumin-to-creatinine ratio (UACR)—are not consistently obtained in clinical practice. In particular, UACR testing is frequently overlooked despite its critical role in identifying kidney damage and guiding risk stratification. Vaduganathan stressed that pharmacists can play a pivotal role in broadening CKD screening efforts and advocating for appropriate laboratory monitoring to facilitate earlier intervention.
He further described how CKD management has evolved toward a pillar-based therapeutic framework, similar to heart failure care. Four classes of disease-modifying therapies—renin-angiotensin system inhibitors, sodium-glucose cotransporter 2 (SGLT2) inhibitors, nonsteroidal mineralocorticoid receptor antagonists (MRAs), and glucagon-like peptide-1 (GLP-1) receptor agonists—have independently demonstrated kidney and cardiovascular benefits in patients with CKD, including those with and without type 2 diabetes. Despite these advances, the primary challenge now lies in improving access, affordability, and real-world implementation of these therapies at a population level.
Vaduganathan also underscored the complexity of CKD care, as many patients are older and experience significant multimorbidity and polypharmacy. In this context, pharmacists are uniquely positioned to streamline medication regimens, deprescribe therapies that may be nonessential or potentially harmful to cardiometabolic health, and reinforce adherence to treatments proven to modify disease progression. Through early detection initiatives, medication optimization, and longitudinal patient engagement, pharmacists can help close care gaps and improve long-term kidney and cardiovascular outcomes in CKD populations.
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