Chronic kidney disease is significantly under-diagnosed in a population that’s most at risk-America’s 26 million diabetics – according to research presented at the 72nd Scientific Sessions of the American Diabetes Association, held here this week.
The multi-site cross-sectional study, Awareness, Detection and Drug Therapy in Type 2 Diabetes Mellitus and Chronic Kidney Disease (ADD-CKD), conducted by the National Kidney Foundation (NKF), assessed the prevalence and proportion of patients with chronic kidney disease in type 2 diabetes, treated within the primary care setting. The research, conducted at 466 primary care provider sites, studied 9,307 patients with diabetes using a clinician survey, a patient physical exam and medical history, lab testing (blood and urine) and patient quality of life questionnaires.
More than 5,000 of those patients had chronic kidney disease, based on albuminuria, or large amounts of protein in the urine, and estimated GFR, a measure of how well the kidneys are functioning. However, only 607 patients were identified as having chronic kidney disease. Clinicians were more successful at diagnosing patients with more advanced chronic kidney disease (stage 3-5) than those with earlier stages (1 and 2) and of the 445 clinicians who enrolled at least 10 patients, 209 (47%) did not identify any of their patients as having CKD. No differences were noted in clinicians’ likelihood of identifying chronic kidney disease based on practice setting, number of years in practice or number of patients seen per week.
“More than 26 million Americans already have chronic kidney disease which represents about 10-15% of the U.S. population. Millions more are at risk due to diabetes which is the leading cause of kidney disease,” said Lynda Szczech, MD., MSCE, Principal Investigator and President of the National Kidney Foundation. “Early detection and treatment of kidney disease in patients with diabetes can help slow progression, reduce cardiovascular events and delay time to kidney failure.
Primary care clinicians are our first line of defense against one of the world’s top killers, yet they have multiple competing priorities. Additionally, the demands of practice are high and the fact that chronic kidney disease guidelines are relatively new compared to diabetes or hypertension has been a barrier in physicians recognizing chronic kidney disease.”
“We need clearer and simpler messages for both primary care clinicians and patients regarding the importance of screening for chronic kidney disease in people with diabetes. We need to educate a way that is memorable, effective and interesting,” continued Szczech.
The dataset will be undergoing further analysis and publication is forthcoming. This research will lead to further longitudinal studies to demonstrate that early recognition and treatment of chronic kidney disease in people with diabetes will improve long term health outcomes.
“We hope this study will be a clarion call to prove recognition of early stage chronic kidney disease so that appropriate preventive measures can be adopted as routine clinical practice. These include using specific diabetes drugs in those with reduced kidney function, avoiding non-steroidal anti-inflammatory drugs (NSAIDs) which can damage the kidneys in those at risk and using kidney-protective medications such as ACE inhibitors and Angiotensin Receptor Blockers (ARBs). We want to use this data to draw attention to the simple fact that recognizing kidney disease and performing simple steps may keep people off dialysis,” said Chester Fox, MD, Professor of Family Medicine, University at Buffalo and ADD-CKD Steering Committee member).
The ADD-CKD study (abstract #2012-LB-5576-Diabetes) is sponsored by Boehringer Ingelheim Pharmaceuticals Inc. and Eli Lilly and Company.
Source: The National Kidney Foundation