Nephrologists Cited Cost as Barrier to CKD Medication
A survey of U.S. providers identified high costs as the primary hurdle in prescribing cardio-kidney protective drugs.
Updated on Oct. 8, 2026 in Diabetes
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Between April and June 2025, researchers surveyed 61 nephrology providers across the United States regarding their prescribing habits for patients with stage 3 chronic kidney disease and type 2 diabetes. The findings revealed that cost represents the leading obstacle for doctors when selecting cardio-kidney protective medications.
Why it matters
The study highlights a significant gap in treatment adherence as providers struggle to balance clinical guidelines with patient financial limitations. Experts suggest that adopting new value-based payment models could help mitigate these costs and potentially reduce future hospitalizations.
A survey of 61 providers, including 44 nephrologists and 17 advanced practice providers, found that 40% of patients used SGLT2 inhibitors and 33% used GLP1 RAs between 2019 and 2024. During this same period, less than 2% of patients utilized nsMRAs.
The details
Authors conducted an anonymous online survey to measure provider-reported obstacles across three primary medication classes used for chronic kidney disease and diabetes management. While most providers were comfortable prescribing SGLT2 inhibitors, 52% reported never having prescribed a GLP1 RA, and 39% had never prescribed an nsMRA.
Timeline
Between 2019 and 2024, patients utilized these cardio-kidney protective medications.
Authors conducted the provider survey from April through June 2025.
The Big Picture
The survey results provide a practical assessment of provider adherence to the National Kidney Foundation's KDOQI clinical practice guidelines. This study identifies why real-world prescribing patterns often fall short of these established standards for disease management.
Patients may face significant financial hurdles when accessing newer cardio-kidney protective therapies due to high out-of-pocket costs. Those managing chronic kidney disease should consult with their healthcare team about potential alternatives or financial assistance programs.
The takeaway
This data underscores the reality that cost often dictates clinical care in the United States, even when effective treatments exist. Policymakers and healthcare organizations must prioritize affordability to ensure patients receive evidence-based care.
What happens next
Study authors have announced plans to conduct future in-depth qualitative interviews with patients, providers, and payers to further explore these financial barriers.
Further reading
For more information on chronic disease management, visit our Diabetes section.
Source note: This article includes information reported by Ajmc.
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