Paving a Path to Equity in Cardiorenal Care

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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 require special attention due to their influence on cardiorenal disease. Despite growing evidence regarding the benefits of disease modifying agents (e.g., SGLT2 inhibitors) for cardiovascular, kidney, and metabolic disease, significant disparities remain in access to and utilization of these essential therapeutics. Multi-level barriers impeding their use require multi-sector interventions which address patient, provider, and health system-tailored strategies. A burgeoning literature also describes the critical role of unequal social determinants of health – or the sociopolitical contexts in which people live and work – on their cardio-renal risk factors including heart failure, diabetes, and chronic kidney disease. This review outlines 1) inequality in the burden and treatment of hypertension, type II diabetes, and heart failure 2) disparities in the use of key disease modifying therapies for cardio-renal-metabolic diseases and 3) multi-level barriers and solutions to achieve greater pharmaco-equity in the use of disease modifying therapies. In addition, this review provides summative evidence regarding the role of unequal social determinants of health in cardio-renal health disparities, further outlining potential considerations for future research and intervention. As proposed in the 2023 American Heart Association presidential advisory on cardiovascular kidney and metabolic health (CKM), a paradigm shift will be needed to achieve cardiorenal health equity. Through a deeper understanding of CKM, and a commitment to equity in the prevention, detection, and treatment of CKM, we can achieve this critical goal.