Efforts are underway to improve CKD detection on World Kidney Disease Day

Today is World Kidney Day, and the National Kidney Foundation is highlighting its work with the Kidney Health Union to nominate targeted screening or case detection for chronic kidney disease based on risk conditions such as diabetes.

NKF has nominated these screenings to the United States Preventive Services Task Force (USPSTF) to reassess the lack of current recommendations. Given the significant racial and ethnic inequality in the diagnosis and treatment of kidney disease exacerbated by the pandemic and socio-economic corruption of COVID-19, this reassessment has been postponed and is becoming increasingly urgent.

Screening efforts

Current evidence tests individuals with diabetes, hypertension and other conditions as recommended by the American Diabetes Society, Kidney Disease to Improve Global Outcomes, and Clinical Practice Guidelines from the Kidney Disease Outcome Quality Initiative. We support that. The main barrier in the United States is the limited use of quantitative albuminuria-creatinine ratio (uACR), with national data showing an annual rate of diabetes of about 40% and an annual rate of hypertension. Is less than 10% and improves the albuminuria test in question.

The lack of current CKD screening recommendations contributes to low testing rates and poor CKD diagnosis in primary care environments. This is a necessary action to tackle Kidney Care For All, the theme of this year’s World Kidney Day.

Over 90% of Americans with kidney disease are unaware that they have it. According to medical service research and the US Kidney Data System, more than 50% of Americans with CKD have uncontrolled diabetes and hypertension, the use of low rates of disease modifiers, suboptimal interdisciplinary care, and the initiation of dialysis. Shows the use of 80% of hemodialysis catheters at the time.

Injustice of health

Inequality of kidney health by race and ethnicity has been recorded since the 1980s. For example, African-American individuals are three to four times more likely to experience renal failure than Caucasian individuals, even though Caucasian individuals are more likely to suffer from diabetes and high blood pressure.

Individuals from Hispanics, Asia, Hawaii, Pacific Islanders, and Native Americans have also recorded group-wide nuanced kidney health inequalities. Americans suffering from renal failure have a low rate of preemptive and early kidney transplants and low access to home dialysis, especially among socio-economically disadvantaged people.

Randomized trials have demonstrated renal and cardiovascular protection using new CKD therapies that increase the potential results and cost-effectiveness of CKD diagnosis. Overwhelming evidence from CREDENCE, DAPA-CKD, and other trials is that SGLT2 inhibitor classes slow the progression of CKD and are associated with cardiovascular events, especially heart failure hospitalization in patients with CKD and type 2 diabetes (T2DM). It shows that it has the effect of reducing risk. As a person without diabetes.

Mortality benefits have also been demonstrated in SGLT2 inhibitor trials. UACR-induced increase in albuminuria is an evidence-based indication for SGLT2 inhibitor therapy, even with normal eGFR, emphasizing the need for testing. Nonsteroidal mineralocorticoid antagonists (MRAs) have also shown reduced CKD progression and heart failure hospitalization in the T2DM and CKD populations.

In addition, observational studies have shown that interdisciplinary care, including primary care clinicians, registered dietitians, pharmacists, and nephrologists, is also associated with improved outcomes for T2DM with CKD.

In addition to protecting the kidneys, it does not necessarily alter the progression of CKD, but reduces the risk of CVD, including statin-based therapies and the drug class of glucagon-like peptide receptor agonists (GLP-1RA) for type 2 diabetes. There are several interventions to do. Several additional studies of SGLT2 inhibitors, nonsteroidal MRA and GLP-1RA classes on renal protective effects are underway.

Finally, prioritizing the development of USPSTF CKD screening recommendations is fundamental to achieving health fairness. In September 2021, the NKF-American Nephrology Society Task Force on Reassessment of Racial Inclusion in the Diagnosis of Kidney Disease Adopts a New Raciallyless Chronic Kidney Disease Epidemic Collaboration 2021 Creatinine Equation to Estimate Kidney Function Recommended. The purpose of the new equation was to minimize the potential consequences of disproportionately affecting one group of individuals. It is important for society to remove racial modifications from clinical algorithms in order to avoid implying the biological causes of race, which is a social component.

NKF is working with large clinical laboratories across the United States to uniformly implement the new eGFR calculation. Fairness in kidney health requires targeted testing and improved access to care, including disease-modifying drugs. Because kidney disease is usually asymptomatic, it is necessary to detect cases of eGFR and uACR in high-risk populations rather than screening in the general or population population.

The evidence base that supports targeted screening in high-risk populations has grown since 2012 and is scaled to review recommendations in favor of the USPSTF.

For more information on World Kidney Day, please visit www.worldkidneyday.org.

For more information:

Joseph A. Vasarotti, MD, He is the Chief Medical Officer of NKF and a clinical professor at Mount Sinai School of Medicine in New York.

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In addition, observational studies have shown that interdisciplinary care, including primary care clinicians, registered dietitians, pharmacists, and nephrologists, is also associated with improved outcomes for T2DM with CKD.