Early and proactive testing: Detecting CKD in patients with T2D

 

People shaking hands

 

Chronic kidney disease (CKD) is a frequent complication of type 2 diabetes (T2D) that affects approximately 40% of patients.1T2D disproportionately affects Black and Hispanic Americans.2 Despite its frequency, most patients are unaware of CKD and the increased risk of cardiovascular events associated with it. Early detection of CKD may improve patient outcomes and help prevent cardiovascular-related events and deaths, so why are fewer than half of at-risk patients adequately tested?

 

Diabetes is estimated to affect over 10% of adults in the U.S., primarily those over the age of 45, with type 2 diabetes (T2D) accounting for 90-95% of cases.2,3 In patients with T2D, up to 40% develop chronic kidney disease (CKD), which damages the kidney and reduces its ability to filter waste.1,4–7 CKD also greatly increases the risk of cardiovascular complications, with the risk of cardiovascular death increasing as CKD progresses.8,9 In fact, patients with stage 3 CKD are over 10 times more likely to die than progress to kidney failure.9 Damage from CKD cannot be reversed, but with the advent of new kidney-protecting treatments, early detection of CKD allows patients and their health care providers to create a plan that may slow CKD progression and reduce cardiovascular risk.

 

Unfortunately, fewer than a quarter of at-risk patients are tested for CKD.10,11 Because many patients are unaware of the disease risk—9 out of 10 patients with CKD do not know they have it—they may not ask their doctors to be screened.12 Without screening, CKD often progresses unnoticed because symptoms do not appear until severe kidney damage occurs and a patient has an imminent need for treatment.13

 

"Type 2 diabetes patients may not be aware of how diabetes affects their kidneys.14,15 This could include chronic kidney disease, a leading comorbidity of diabetes, and negatively affects other organ systems as well, especially the heart."

Amit Sharma , U.S. Vice President Cardiovascular & Renal, Medical Affairs at Bayer Pharmaceuticals

Early Detection Could Save Lives

Early detection of CKD is critical—if detected before severe damage has occurred, you can take steps to slow CKD progression.10,11 Testing for CKD is done using estimated glomerular filtration rate (eGFR) and urine albumin-to-creatinine ratio (uACR).4,5,11 Measurement of eGFR allows doctors to tell how well a kidney is functioning, and uACR tests for protein (albumin) in the urine, as a marker of kidney damage. Using not only one but both measurements to screen for CKD is critical, as this can detect kidney damage that may be missed using only eGFR.5

 

However, less than one-fifth of at-risk patients are tested for CKD using both eGFR and uACR.11 While 89.6% of at-risk patients are tested using eGFR (often as a part of a routine physical), only 21% are tested using uACR.11 This means that kidney damage—and therefore potentially CKD— in some patients with T2D is being missed. Because CKD is closely connected to risk of cardiovascular events, testing using both measurements is extremely important. Remember, T2D patients with stage 3 CKD are over 10 times more likely to suffer a fatal cardiovascular event than to suffer kidney failure, so using both eGFR and uACR to screen for CKD is highly desired.9

 

Treating CKD to Minimize Cardiovascular Events

Diagnosing CKD early before it can progress to kidney failure is key to improving patient outcomes.10,13 Once CKD is diagnosed, there are medicines available that can slow CKD progression and reduce the risk of cardiovascular events.10 Medicines like ACE inhibitors and angiotensin receptor blockers are recommended in patients with CKD associated with T2D, and there are new treatments that slow CKD progression.10

 

As CKD progresses, the ability to use every tool in the treatment toolbox is invaluable. To keep all the tools available, early detection of CKD—through screening with both eGFR and uACR—is of utmost importance for better patient outcomes.10

 

About Bayer’s Commitment in Cardiovascular and Kidney Diseases

Bayer is an innovation leader in the area of cardiovascular diseases, with a long-standing commitment to delivering science for a better life by advancing a portfolio of innovative treatments. The heart and the kidneys are closely linked in health and disease, and Bayer is working in a wide range of therapeutic areas on new treatment approaches for cardiovascular and kidney diseases with high unmet medical needs. The cardiology franchise at Bayer already includes a number of products and several other compounds in various stages of preclinical and clinical development. Together, these products reflect the company’s approach to research, which prioritizes targets and pathways with the potential to impact the way that cardiovascular diseases are treated.

 

References

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  2. Menke A, Casagrande S, Geiss L, Cowie CC. Prevalence of and trends in diabetes among adults in the United States, 1988-2012. JAMA. 2015;314(10):1021-1029. doi:10.1001/jama.2015.10029
  3. Centers for Disease Control and Prevention (CDC). National Diabetes Statistics Report 2020: Estimates of Diabetes and Its Burden in the United States. Centers for Disease Control and Prevention; 2020:32.
  4. Alicic RZ, Rooney MT, Tuttle KR. Diabetic kidney disease: challenges, progress, and possibilities. Clin J Am Soc Nephrol. 2017;12(12):2032-2045. doi:10.2215/CJN.11491116
  5. KDIGO. KDIGO 2012 clinical practice guideline for the evaluation and management of chronic kidney disease. Kidney Int Suppl. 2013;3(1). Accessed September 15, 2021. https://kdigo.org/wp-content/uploads/2017/02/KDIGO_2012_CKD_GL.pdf
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  7. Thomas MC, Cooper ME, Zimmet P. Changing epidemiology of type 2 diabetes mellitus and associated chronic kidney disease. Nat Rev Nephrol. 2016;12(2):73-81. doi:10.1038/nrneph.2015.173
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  9. Matsushita K, van der Velde M, Astor BC, et al. Association of estimated glomerular filtration rate and albuminuria with all-cause and cardiovascular mortality in general population cohorts: a collaborative meta-analysis. Lancet Lond Engl. 2010;375(9731):2073-2081. doi:10.1016/S0140-6736(10)60674-5
  10. Pálsson R, Patel UD. Cardiovascular complications of diabetic kidney disease. Adv Chronic Kidney Dis. 2014;21(3):273-280. doi:10.1053/j.ackd.2014.03.003
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  12. Alfego D, Ennis J, Gillespie B, et al. Chronic kidney disease testing among at-risk adults in the U.S. remains low: real-world evidence from a national laboratory database. Diabetes Care. Published online July 9, 2021. doi:10.2337/dc21-0723
  13. Centers for Disease Control and Prevention (CDC). Chronic Kidney Disease in the United States, 2021. US Department of Health and Human Services; 2021. Accessed August 30, 2021. https://www.cdc.gov/kidneydisease/publications-resources/ckd-national-facts.html
  14. American Kidney Fund. Stages of chronic kidney disease (CKD). American Kidney Fund. Published September 15, 2021. Accessed September 25, 2021. http://www.kidneyfund.org/kidney-disease/chronic-kidney-disease-ckd/stages-of-chronic-kidney-disease/
  15. National Kidney Foundation. Does type 2 diabetes increase your risk for kidney disease? Yes. National Kidney Foundation. Published January 28, 2021. Accessed August 30, 2021. https://www.kidney.org/atoz/content/does-type-2-diabetes-increase-your-risk-kidney-disease-yes
  16. Chu CD, McCulloch CE, Banerjee T, et al. CKD awareness among US adults by future risk of kidney failure. Am J Kidney Dis. 2020;76(2):174-183. doi:10.1053/j.ajkd.2020.01.007