Chronic kidney disease is a very frequent and significantly under-diagnosed clinical condition, even in patients with known risk factors that can cause it such as diabetes, hypertension and heart failure. In particular, in Italy, as many as 77% of patients with this early stage (Stage 3) disease remain undiagnosed. On the occasion of the American Society of Nephrology (ASN) Kidney Week 2022, which took place in Orlando (Florida, United States), new data on the importance of screening and early diagnosis of Chronic Kidney Disease (CKD) were presented and the impact of dapagliflozin on reducing healthcare costs. The results were also published at the same time in the Journal of the American Society of Nephrology.
Una malattia underdiagnosticata
Chronic kidney disease affects 850 million people worldwide with an increasing prevalence, however, in the vast majority of cases it goes undiagnosed. Data from the multinational REVEAL-CKD study showed high rates of underdiagnosis, ranging from 61.6% to 95.5%, in the countries considered in the study (United States, Italy, Germany, Japan and France). For evaluation of patients with estimated glomerular filtration rate (eGFR) between ≥30 and <60 mL / min / 1.73 m2, (CKD Stage 3), who had not received a previous diagnosis of the disease, the electronic medical records and databases specific to each country were analyzed. This analysis also showed that, once the diagnosis was made, the patients were monitored and treated promptly and consistently with what is indicated in the Guidelines.
The decline in kidney function
The importance of early diagnosis of CKD is evident from the impact that CKD itself has on the annual decline in renal function, expressed by the eGFR. The REVEAL-CKD study evaluated, in fact, the variation of eGFR before and after the diagnosis of CKD in the cohort of 27,000 patients of the American database TriNetX. These patients had a median decline in eGFR in the two years prior to disease diagnosis of -4.12 (Confidence interval [CI] 95%: -4.23, -4.02) and only -0.30 (95% CI: -0.44, -0.14) in the two years following diagnosis. “Early diagnosis of CKD is crucial in slowing the progressive decline in kidney function and its progression to its end stage (irreversible decline in kidney function resulting in the need for dialysis or kidney transplantation). Nonetheless, it remains largely under-diagnosed especially in its early stages, ”he explains luca de nicolaFull Professor of Nephrology at the Luigi Vanvitelli University of Campania in Naples.
The Italian data
In the Italian analysis of the REVEAL-CKD study, clinical data extracted from electronic medical records of 900 general practitioners and administrative databases were evaluated, for a total of 1.2 million patients (in the period 2015-2021). The study cohort included 65,676 patients, of which 58% were women. The overall prevalence of undiagnosed CKD was 77%. “The Italian analysis of REVEAL-CKD – continues De Nicola – shows the very high percentage of patients with undiagnosed CKD stage 3; in particular patients over the age of 65 and female, and also in the presence of comorbidities such as diabetes, heart failure and arterial hypertension. The data from the REVEAL-CKD study therefore confirm the need for early screening for a timely diagnosis of the disease already in its early stages, so that the greatest number of patients can receive optimal management and treatment adhering to guidelines. so as to prevent or delay its progression to its terminal stages “.
Healthcare costs
In addition to unmet clinical needs, the health care costs associated with CKD are significant, especially as it progresses to its terminal stages with the onset of cardiorenal events. In this perspective, the INSIDE-CKD study estimated the economic savings of direct costs of medical care resulting from a lower incidence of clinical events, showing how dapagliflozin can significantly reduce the use of healthcare resources by delaying the progression of CKD and reducing the incidence of cardiorenal events. From the aggregate analysis of 23 countries, including Italy, it was shown that out of 100,000 patients treated with dapagliflozin in addition to standard of care, compared to standard of care alone, there would be a reduction of 33% in costs, with savings of 205 million dollars in three years.
The reduction of hospitalizations
Further analysis of the data from the DAPA-CKD study presented at ASN Kidney Week also showed that dapagliflozin treatment reduced the rate of hospitalization for all causes, among patients with CKD, with or without diabetes mellitus. Type 2 (T2D). These results demonstrate the implications not only on patients’ quality of life, but also on the overall health burden and costs attributed to treating CKD. In addition to presenting data at ASN Kidney Week 2022 on the urgent need for early diagnosis and screening, AstraZeneca supported the International Society of Nephrology in creating the test to understand whether a patient may be at risk for CKD and to provide more information on the risk factors to be aware of and to direct him to speak to his doctor.
Chronic kidney disease (CKD)
Chronic kidney disease can be a severe and progressive condition defined by decreased kidney function (demonstrated by a decrease in estimated glomerular filtrate (eGFR) or markers of kidney damage, or both, for at least three months). The most common causes of CKD are diabetes, hypertension and glomerulonephritis. Chronic kidney disease is associated with significant comorbidities and an increased risk of cardiovascular events, such as HF and premature death. In its most severe form, known as end-stage kidney disease, kidney damage and deterioration of its function progress to the stage where dialysis or kidney transplantation is required. Most CKD patients die from CV causes before reaching the form of ESKD.