{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,25]],"date-time":"2026-10-25T03:48:40Z","timestamp":1792900120148,"version":"4.5.0"},"reference-count":98,"publisher":"Oxford University Press (OUP)","issue":"3","funder":[{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["UL1TR000124"],"award-info":[{"award-number":["UL1TR000124"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["P30AG021684"],"award-info":[{"award-number":["P30AG021684"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000062","name":"National Institute of Diabetes and Digestive and Kidney Diseases","doi-asserted-by":"publisher","award":["R01DK112008"],"award-info":[{"award-number":["R01DK112008"]}],"id":[{"id":"10.13039\/100000062","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,2,28]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>For the first time in many years, guideline-directed drug therapies have emerged that offer substantial cardiorenal benefits, improved quality of life and longevity in patients with chronic kidney disease (CKD) and type 2 diabetes. These treatment options include sodium-glucose cotransporter-2 inhibitors, nonsteroidal mineralocorticoid receptor antagonists and glucagon-like peptide-1 receptor agonists. However, despite compelling evidence from multiple clinical trials, their uptake has been slow in routine clinical practice, reminiscent of the historical evolution of angiotensin-converting enzyme inhibitor and angiotensin II receptor blocker use. The delay in implementation of these evidence-based therapies highlights the many challenges to optimal CKD care, including: (i) clinical inertia; (ii) low CKD awareness; (iii) suboptimal kidney disease education among patients and providers; (iv) lack of patient and community engagement; (v) multimorbidity and polypharmacy; (vi) challenges in the primary care setting; (vii) fragmented CKD care; (viii) disparities in underserved populations; (ix) lack of public policy focused on health equity; and (x) high drug prices. These barriers to optimal cardiorenal outcomes can be ameliorated by a multifaceted approach, using the Chronic Care Model framework, to include patient and provider education, patient self-management programs, shared decision making, electronic clinical decision support tools, quality improvement initiatives, clear practice guidelines, multidisciplinary and collaborative care, provider accountability, and robust health information technology. It is incumbent on the global kidney community to take on a multidimensional perspective of CKD care by addressing patient-, community-, provider-, healthcare system- and policy-level barriers.<\/jats:p>","DOI":"10.1093\/ndt\/gfac283","type":"journal-article","created":{"date-parts":[[2022,10,7]],"date-time":"2022-10-07T17:05:22Z","timestamp":1665162322000},"page":"532-541","source":"Crossref","is-referenced-by-count":79,"title":["Overcoming barriers to implementing new guideline-directed therapies for chronic kidney disease"],"prefix":"10.1093","volume":"38","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1201-6344","authenticated-orcid":false,"given":"Robert","family":"Nee","sequence":"first","affiliation":[{"name":"Nephrology Service, Walter Reed National Military Medical Center , Bethesda, MD , USA"},{"name":"Department of Medicine, Uniformed Services University , Bethesda, MD , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4805-6359","authenticated-orcid":false,"given":"Christina M","family":"Yuan","sequence":"additional","affiliation":[{"name":"Nephrology Service, Walter Reed National Military Medical Center , Bethesda, MD , USA"},{"name":"Department of Medicine, Uniformed Services University , Bethesda, MD , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew S","family":"Narva","sequence":"additional","affiliation":[{"name":"College of Agriculture, Urban Sustainability and Environmental Studies, University of the District of Columbia , Washington, DC , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guofen","family":"Yan","sequence":"additional","affiliation":[{"name":"Department of Public Health Sciences, University of Virginia School of Medicine , Charlottesville, VA , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Keith C","family":"Norris","sequence":"additional","affiliation":[{"name":"Department of Medicine, David Geffen School of Medicine, University of California at Los Angeles , Los Angeles, CA , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2022,10,20]]},"reference":[{"key":"2023030115325748500_","doi-asserted-by":"crossref","first-page":"1590","DOI":"10.2215\/CJN.18641120","article-title":"Transforming the care of patients with diabetic kidney disease","volume":"16","author":"Brosius","year":"2021","journal-title":"Clin J Am Soc Nephrol"},{"key":"2023030115325748500_","doi-asserted-by":"crossref","first-page":"S1","DOI":"10.1016\/j.kint.2020.06.019","article-title":"KDIGO 2020 clinical practice guideline for diabetes management in chronic kidney disease","volume":"98","author":"Kidney Disease: Improving Global Outcomes (KDIGO) Diabetes Work Group","year":"2020","journal-title":"Kidney Int"},{"key":"2023030115325748500_","doi-asserted-by":"crossref","first-page":"S175","DOI":"10.2337\/dc22-S011","article-title":"11. 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