UPMC's Dr Manisha Jhamb Urges Better Kidney Disease Awareness, Integrated Care

Manisha Jhamb, MD, MPH, nephrologist, director of the Center for Population Health Management, and associate professor of medicine in the renal-electrolyte division at the University of Pittsburgh Medical Center, is enthusiastic about CMS's announcement of negotiated drug prices under the Inflation Reduction Act (IRA), especially for patients with kidney disease facing affordability and access issues.

However, she noted that kidney disease awareness remains a major barrier as many patients are unaware they have it until it's advanced. Lastly, looking ahead to 2025, Jhamb is focused on holistically integrating cardio-renal-metabolic care and developing comprehensive treatment guidelines for multiple subspecialties.

This transcript has been lightly edited for clarity.

Transcript

CMS recently announced the negotiated drug prices for the first 10 drugs under the IRA. What is your reaction to the announced prices?

I'm very excited. This is a big step, especially for our patients with kidney disease, who a lot of times may have affordability and access issues for these medications. These are truly life-changing medicines for these patients, so it's really great to see the movement going forward to make these medications more accessible, especially for our patients who have a lot of social risk factors.

Kidney disease disproportionately affects some of our minority populations, including Blacks and Hispanics; for those patients, this is a great step forward.

What are some of the most prevalent barriers to care among patients with chronic kidney disease?

I think first and foremost is just awareness of having kidney disease. One in 9 patients with kidney disease don't even know they have it. Even those with stage 4, or pretty advanced kidney disease, half of them don't know they have it. So, that is one of the biggest barriers. Kidney disease is a silent disease, people don't have any symptoms from it until it's too advanced.

In addition to that, a lot of times we are not talking—their providers, their clinicians are not talking to them enough about kidney disease and what we can do about this. The big challenge for that is for over 20 years, we never had medications. There were a few medications in the past, but now it's exciting to see newer drug classes coming into this field.

The challenge right now is to make sure everybody has access and affordability to these medications, [and that] our clinicians are comfortable prescribing these and are working towards implementing some of these guidelines in clinical practice.

What changes in the cardio-renal-metabolic landscape are you keeping an eye on for 2025?

I think one of the big things is how we approach cardio-renal-metabolic care in [a more holistic fashion], both for the primary care physician to implement and also for the patient to understand and adhere to.

It will take a lot of effort to bring all the subspecialties together to develop some algorithms and treatment guidelines and figure out how we can best serve our patients.