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Cost and availability of medication In high-income countries, people without health insurance and those with high copays paradoxically pay the most for even essential medications.38 Across LMICs, kidney disease is the leading cause of catastrophic health expenditure because of reliance on out-of-pocket payments.56 Across 18 countries, 4 cardiovascular disease medications (statins, ACEIs, aspirin, and -blockers), all often indicated in CKD, were more available in private than in public settings, mostly unavailable in rural communities, and unaffordable for 25% of people in upper middle-income countries and 60% of people in low-income countries.57 Newer therapies may be prohibitively expensive worldwide, especially where generics may not yet be available

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can be divided into three different classes, based on their chemical structure and mechanism of action