Unmasking Chronic Kidney Disease and Economic Implications
By Danélia Botes
January 22, 2024
Exploring Chronic Kidney Disease
Chronic Kidney Disease (CKD) is a widespread and often undetected health crisis, impacting around 15% of the American population. This amounts to a staggering 37 million individuals. Alarmingly, 90% of adults with the condition are not aware of their diagnosis. This article is based on an insightful recently published interview with nephrologist Sylvia Rosas, MD. It will explore the implications of recent research on CKD screening. Furthermore, looking at new medicines for cardiorenal protection, and the economic factors surrounding CKD management.
Unmasking the Silent Epidemic
CKD is a stealthy disease, often asymptomatic until it progresses to severe stages. Current healthcare strategies focus on screening individuals with underlying conditions such as diabetes and hypertension, which are known risk factors for CKD. However, this approach misses a large number of individuals who do not fall into these risk categories. The American Heart Association (AHA) uses the term cardiovascular-kidney-metabolic (CKM) syndrome to characterize obesity, diabetes, CKD, and cardiovascular disease that occur simultaneously. They are suggesting a staged approach in monitoring these patients to limit the development of severe kidney disease.
The Importance of Early Screening
Early detection is crucial in CKD and there is a need to identify these patients before they develop severe disease. All asymptomatic patients over the age of 35 should be screened. This a potential cost saving strategy suggested by a recent study from Stanford University. Yet, in the United States, the rate of CKD screening lags behind other preventive screenings, despite its low cost and simplicity. The need for increased CKD screening is clear, as late detection often results in the need for dialysis or transplantation.
New Treatments on the Horizon
CKD treatment has seen significant advancements with the introduction of new drugs such as sodium-glucose cotransporter 2 (SGLT2) inhibitors and mineralocorticoid receptor antagonists (MRAs). These drugs not only help manage the disease but also have been shown to reduce the risk of loss of kidney function. The standard of care for CKD has always been focused on treating comorbid conditions such as diabetes and hypertension. With the introduction of SGLT2 and MRAs we can substantially lower the risk of reduced kidney function. Updated guidelines include the use of SGLTs treatment in CKD patients with an eGFR ≥20. The risk of death or hospitilisaion with heart failure has also been shown to reduce when diabetes patients are treated with SGLT2 treatments.
The Economics of CKD Treatment
The cost-effectiveness of CKD treatment is an important consideration. The first published study on CKD patients using SGLT2s without diabetes indicated a 48% reduced mortality rate. The use of dapagliflozin resulted in 2 years improved life expectancy and 6% reduction in need for dialysis or kidney transplant. According to Stanford research on the cost effectiveness of screening asymptomatic adults for CKD, a one-time screening at age 55 years yielded an incremental cost-effectiveness ratio of $86,300 per Quality-Adjusted Life Year (QALY). The need for either dialysis or renal transplant was reduced by 398 000 cases. These figures highlight the economic viability of early detection and treatment of CKD.
The Future of CKD Screening
Given the potential of these new treatments, the National Kidney Foundation and the American Kidney Fund have called for a fresh review of CKD screening recommendations. The hope is that increased awareness and updated screening guidelines will lead to earlier detection and treatment. This would improve outcomes for millions of individuals living with this widespread healthcare crisis.
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