Paving a Path to Equity in Cardiorenal Care

IF 2.8 3区 医学 Q2 UROLOGY & NEPHROLOGY Seminars in nephrology Pub Date : 2024-03-01 DOI:10.1016/j.semnephrol.2024.151519
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Abstract

Cardiorenal syndrome encompasses a dynamic interplay between cardiovascular and kidney disease, and its prevention requires careful examination of multiple predisposing underlying conditions. The unequal distribution of diabetes, heart failure, hypertension, and kidney disease requires special attention because of the influence of these conditions on cardiorenal disease. Despite growing evidence regarding the benefits of disease-modifying agents (e.g., sodium-glucose cotransporter 2 inhibitors) for cardiovascular, kidney, and metabolic (CKM) disease, significant disparities remain in access to and utilization of these essential therapeutics. Multilevel barriers impeding their use require multisector interventions that address patient, provider, and health system-tailored strategies. Burgeoning literature also describes the critical role of unequal social determinants of health, or the sociopolitical contexts in which people live and work, in cardiorenal risk factors, including heart failure, diabetes, and chronic kidney disease. This review outlines (i) inequality in the burden and treatment of hypertension, type 2 diabetes, and heart failure; (ii) disparities in the use of key disease-modifying therapies for CKM diseases; and (iii) multilevel barriers and solutions to achieve greater pharmacoequity in the use of disease-modifying therapies. In addition, this review provides summative evidence regarding the role of unequal social determinants of health in cardiorenal health disparities, further outlining potential considerations for future research and intervention. As proposed in the 2023 American Heart Association presidential advisory on CKM health, a paradigm shift will be needed to achieve cardiorenal health equity. Through a deeper understanding of CKM health and a commitment to equity in the prevention, detection, and treatment of CKM disease, we can achieve this critical goal.

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为实现心肾护理公平铺平道路。
心肾综合征包括心血管疾病和肾脏疾病之间的动态相互作用,预防心肾综合征需要仔细检查多种诱发因素。糖尿病、心力衰竭、高血压和肾脏疾病的分布不均需要特别关注,因为这些疾病会对心肾疾病产生影响。尽管越来越多的证据表明,改变病情的药物(如钠-葡萄糖共转运体 2 抑制剂)对心血管、肾脏和新陈代谢(CKM)疾病大有裨益,但在获得和使用这些基本治疗药物方面仍存在巨大差距。阻碍这些药物使用的多层面障碍要求采取多部门干预措施,针对患者、医疗服务提供者和医疗系统制定相应的策略。越来越多的文献还描述了不平等的健康社会决定因素或人们生活和工作的社会政治环境在心力衰竭、糖尿病和慢性肾病等心肾风险因素中的关键作用。本综述概述了:(i) 高血压、2 型糖尿病和心力衰竭在负担和治疗方面的不平等;(ii) 针对慢性肾脏病的主要疾病调节疗法在使用方面的差异;(iii) 在使用疾病调节疗法方面实现更大药物平等的多层次障碍和解决方案。此外,本综述还就不平等的健康社会决定因素在心肾健康差异中的作用提供了总结性证据,进一步概述了未来研究和干预的潜在考虑因素。正如 2023 年美国心脏协会主席关于 CKM 健康的建议所提出的那样,要实现心肾健康公平,就必须转变模式。通过加深对心肾炎健康的了解,并致力于心肾炎疾病的预防、检测和治疗的公平性,我们可以实现这一关键目标。Semin Nephrol 36:x-xx © 20XX Elsevier Inc.保留所有权利。
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来源期刊
Seminars in nephrology
Seminars in nephrology 医学-泌尿学与肾脏学
CiteScore
5.60
自引率
0.00%
发文量
27
审稿时长
6-12 weeks
期刊介绍: Seminars in Nephrology is a timely source for the publication of new concepts and research findings relevant to the clinical practice of nephrology. Each issue is an organized compendium of practical information that serves as a lasting reference for nephrologists, internists and physicians in training.
期刊最新文献
Table of Contents Editorial Board Masthead Electronic Collection of Patient-Reported Outcomes to Improve Kidney Care: Benefits, Drawbacks, and Next Steps Patient-Reported Outcomes to Achieve Person-Centered Care for Aging People With Kidney Disease
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