Chronic Kidney Disease

Chronic Kidney Disease

An unmet need in chronic kidney disease

Chronic kidney disease (CKD) is an increasingly common and costly public health concern, occurring in just under 10% of individuals worldwide^1,2. CKD presents a significant personal and socioeconomic burden as it is progressive, leading to nephron loss, end-stage kidney disease (ESKD) and in some cases, premature death. CKD is increasing in prevalence with an ageing population and a rise in comorbidities, particularly diabetes and hypertension. Diabetic kidney disease (DKD) occurs in around 40% of diabetic patients, and is the most common cause of kidney failure, while hypertension causes around 25% of kidney failure^1,3. In low and middle sociodemographic countries, patients who do not die during progression of CKD usually die within months when they reach ESKD due to unavailable renal replacement therapy or inadequate dialysis². Current treatment strategies for CKD aim to slow down progression; however, they are often implemented too late. Many individuals remain asymptomatic until later stages of disease, with <5% of patients with CKD reporting awareness of their disease⁴. Earlier diagnosis and management of comorbid conditions associated with CKD onset play an important role in CKD management, alongside strategies for managing CKD directly.

Early chronic kidney disease diagnosis

There is significant variation in the diagnostic methods used to detect CKD⁵ and simple tests such as urine albumin to creatinine are still not standard practice, even in high income countries². Further, factors such as age-related structural and functional changes of the kidney, along with comorbidities, often make CKD difficult to recognise and refer, particularly in the elderly. With diagnostic strategies and treatments now widely available for CKD, screening of high-risk individuals and guidance on early diagnosis is critical for effective management and prevention of kidney damage accrual, CKD complications, and ESKD^2,6,7. It is essential that the benefits of early CKD diagnosis, risk factors for CKD, and guidance on the available assessment and screening strategies for assessing risk of CKD in different patient settings, are fully understood.

Managing chronic kidney disease

CKD is managed according to stage of disease. At early stages of CKD, management includes lifestyle changes and effective management of comorbid conditions, including hypertension and diabetes. CKD monitoring strategies are also employed to screen for complications of CKD, such as hyperkalaemia, vitamin D deficiency, and secondary hyperparathyroidism, with those at high risk of CKD progression being referred to a nephrologist⁴. For late-stage CKD (stage 5), dialysis and kidney transplant may be necessary, both presenting very high treatment burdens. A major treatment goal for CKD is to prevent progression to stage 5 kidney disease. An important step in achieving this goal is understanding the importance of managing concordant comorbid conditions in CKD such as diabetes and hypertension, and treatment options for CKD and their utility in different CKD patient groups, to ensure optimal treatment is given for each CKD patient.

References

1. Tuttle KR. SGLT2 inhibition and chronic kidney disease outcomes: in diabetes and beyond. Lancet Diabetes Endocrinol. 2021;9(1):3–5.
2. Cockwell P, Fisher L-A. The global burden of chronic kidney disease. Lancet. 2020;395(10225):662–664.
3. Alicic RZ, Rooney MT, Tuttle KR. Diabetic Kidney Disease: Challenges, Progress, and Possibilities. Clin J Am Soc Nephrol. 2017;12(12):2032.
4. Chen TK, Knicely DH, Grams ME. Chronic Kidney Disease Diagnosis and Management: A Review. JAMA - J Am Med Assoc. 2019;322(13):1294–1304.
5. Gheewala PA, Zaidi STR, Jose MD, Bereznicki L, Peterson GM, Castelino RL, et al. Effectiveness of targeted screening for chronic kidney disease in the community setting: a systematic review. J Nephrol. 2018;31(1):27–36.
6. Aucella F, Corsonello A, Leosco D, Brunori G, Gesualdo L, Antonelli-Incalzi R. Beyond chronic kidney disease: the diagnosis of Renal Disease in the Elderly as an unmet need. A position paper endorsed by Italian Society of Nephrology (SIN) and Italian Society of Geriatrics and Gerontology (SIGG). J Nephrol. 2019;32(2):165–176.
7. Tonelli M, Dickinson JA. Early Detection of CKD: Implications for Low-Income, Middle-Income, and High-Income Countries. J Am Soc Nephrol. 2020;31(9):1931–1940.
8. Eddy S, Mariani LH, Kretzler M. Integrated multi-omics approaches to improve classification of chronic kidney disease. Nat Rev Nephrol. 2020;16(11):657–668.