DavidJ_PLM wrote the cited article “Why is Kidney Disease so Often Undiagnosed?” in the 15 Jan 2024 Patientslikeme portal provided by Fresenius. I have quoted it in its entirety below. Tomorrow’s blog will delve into the new medicines cited.
18 Jan 2024
DavidJ_PLMPLM STAFF
Approximately 37 million Americans, constituting 15% of the population, suffer from chronic kidney disease (CKD). Alarmingly, 9 in 10 adults with CKD are unaware of their diagnosis. A recent study from Stanford University suggests that screening asymptomatic adults over 35 could be a cost-effective strategy for identifying CKD before it progresses to severe illness.
Screening For CKD
Currently, the standard of care involves screening individuals with underlying conditions that elevate CKD risk, such as diabetes and hypertension. However, real-world implementation lags behind recommendations, leading to underdiagnosis. Only 40% of insured individuals with diabetes and 10% with hypertension receive both the glomerular filtration rate (GFR) and albumin tests needed for CKD screening.
Early detection is crucial, as symptoms of CKD are often nonspecific and patients may remain asymptomatic until it’s too late to prevent the need for dialysis or transplantation. Despite the low-cost and simplicity of CKD screening, it falls behind other preventive screenings in terms of implementation.
New Drug Treatments
New drugs, such as sodium-glucose cotransporter 2 (SGLT2) inhibitors and mineralocorticoid receptor antagonists (MRAs), offer promising avenues for CKD treatment. SGLT2 inhibitors have shown significant reductions in the risk of kidney function loss. MRAs, particularly the nonsteroidal variety like finerenone, demonstrate efficacy in reducing cardiovascular events and CKD outcomes.
Advancements in CKD treatment have prompted calls for a reevaluation of CKD screening recommendations. The National Kidney Foundation and the American Kidney Fund have urged the US Preventive Services Task Force (USPSTF) to review recent data. Recent studies suggest that screening asymptomatic adults, coupled with the use of new drugs, can significantly reduce the incidence of kidney replacement therapy and improve quality-adjusted life years.
The Future of Care
While the USPSTF review is ongoing, there’s optimism that the incorporation of best practice alerts in electronic health record systems, coupled with interdisciplinary care models involving primary care doctors, nephrologists, cardiologists, and endocrinologists, can enhance CKD screening and treatment implementation.
I agree 100% with the delay of screening for kidney failure. I received a phone call telling me I was STAGE 4 and needed to see a kidney specialist: what?????? The only question I was ever asked was “are you drinking lots of water”” My answer was always ‘yes’. Then BOOM! I was scared to pieces. At least my diagnosis with the nephrologist was Stage 3, so I could at least breathe at that point.
Hey Hank, better change your ‘age’ on this page!!