Evidence mapPaperPMID 36264305Full record

ArticleNephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association2023

Overcoming barriers to implementing new guideline-directed therapies for chronic kidney disease.

Robert Nee, Christina M Yuan, Andrew S Narva, Guofen Yan, Keith C Norris

Open access · bronzeAbstract read
In one paragraph

Article in Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 39 papers, 2 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
39citing papers in PubMed, 2 pooled it
8.1field-weighted citation impact, top 2% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

39 citing papers in PubMed, 2 syntheses or guidelines pooled it, 63 citations in OpenAlex.

  1. Pooled it
  2. Pooled it
  3. Review
  4. Review
  5. Article
  6. Review
  7. Addressing Unmet Needs in the Management of Chronic Kidney Disease.International journal of general medicine · 2026
    Review
  8. Article
  9. Article
  10. Review
  11. Circulating and Urinary CCL20 in Human Kidney Disease.International journal of molecular sciences · 2025
    Article
  12. Article
  13. Review
  14. Article
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  16. Article
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

5 authors at 4 institutions in 1 country.

Robert NeeNephrology Service, Walter Reed National Military Medical Center, Bethesda, MD, USA.ORCID 0000-0003-1201-6344
Christina M YuanNephrology Service, Walter Reed National Military Medical Center, Bethesda, MD, USA.ORCID 0000-0002-4805-6359
Andrew S NarvaCollege of Agriculture, Urban Sustainability and Environmental Studies, University of the District of Columbia, Washington, DC, USA.
Guofen YanDepartment of Public Health Sciences, University of Virginia School of Medicine, Charlottesville, VA, USA.
Keith C NorrisDepartment of Medicine, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA, USA.
Uniformed Services University of the Health Sciences · USUniversity of California, Los Angeles · USUniversity of the District of Columbia · USUniversity of Virginia · US

Funding

UCLA Clinical and Translational Science InstituteUL1TR001881 · UNIVERSITY OF CALIFORNIA LOS ANGELES · 2025 to 2025
$9.9M
The Center for Health Improvement of Minority ElderlyP30AG021684 · UNIVERSITY OF CALIFORNIA LOS ANGELES · 2002 to 2025
$4.0M
Differential survival selections and care-related determinants among African Americans and Hispanics versus whites with chronic kidney diseaseR01DK112008 · NIDDK · UNIVERSITY OF VIRGINIA · PI Guofen Yan · 2021 to 2021
$351k
NCATS NIH HHS UL1 TR000124NCATS NIH HHS UL1 TR001881NIA NIH HHS P30 AG021684NIDDK NIH HHS R01 DK112008
6 · The paper itself

Abstract

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.

Indexed as

Diabetes Mellitus, Type 2Renal Insufficiency, ChronicSodium-Glucose Transporter 2 InhibitorsHumansKidneyQuality of LifeSodium-Glucose Transporter 2 Inhibitorscardiovascular diseasechronic kidney diseasediabetes mellitusglucagon-like peptide-1 receptor agonistnonsteroidal mineralocorticoid receptor antagonistsodium-glucose cotransporter-2 inhibitor

Identifiers

PMID36264305
PMCPMC9976771
OpenAlexW4306901791

What Socratic holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.