Real-World Data Highlight Diagnostic Delays, Underdiagnosis of CKD

Globally, chronic kidney disease (CKD) is considered a widespread health concern with increasing prevalence. To address gaps in knowledge surrounding CKD diagnosis and management, 2 posters presented at ASN Kidney Week 2023 highlighted real-world data on the state of CKD in the United States and globally to inform future approaches to the diagnosis and treatment of patients with CKD.

Studies utilizing real-world data have the advantage of analyzing disease states, severity, prevalence, and other factors across diverse cohorts of patients that can be more difficult to represent in standard, randomized clinical trials.

CKD Stages | image credit: marina-ua - stock.adobe.com

At ASN Kidney Week 2023, Pollock et al presented data gathered from the iCaReMe Global Registry to investigate the worldwide state of CKD, including major risk factors, disease management, and presenting clinical features. The iCaReMe registry is an ongoing prospective, multinational, observational study that assess the quality of care and management of patients with CKD, type 2 diabetes (T2D), hypertension (HTN), and/or heart failure (HF). The cohort consisted of individuals enrolled between February 2018 to December 2022.¹

The investigators found that one of the key obstacles in providing adequate care for CKD comes from poor screening and underdiagnoses of patients. Initiating treatment in earlier stages is beneficial for slowing the progression of CKD as well as minimizing cardiovascular risks.

In total, 2977 adults with CKD were identified, and the median age in the cohort was approximately 60 years. These patients represented 21 countries throughout 6 World Health Organization (WHO) regions. Among the most prevalent etiologies were diabetic kidney disease (DKD), which affected over 44% of individuals; and hypertensive kidney disease (HKD), which affected over 34% of patients. Comorbidities such as HTN, T2D, dyslipidemia, and HF were observed in approximately 80%, 72%, 44%, and 35% of enrolled patients, respectively.

Their data also demonstrated that the overall mean urine albumin-to-creatine ratio (UACR) was 556.7 mg/g in patients; those with CKD + HTN exhibited an average UACR of 609.3 mg/g; those with CKD + T2D had an average UACR of 406.3 mg/g. Additionally, the overall mean estimated glomerular filtration rate (eGFR) was 46.1 mL/min/1.732; patients with CKD + HTN or CKD +T2D had averages of 42.7 mL/min/1.732 and 48.6 mL/min/1.732, respectively. UACR data was reported in 30% of individuals, and eGFR was reported in over 83%.

In the study period, nearly 38% of patients were prescribed an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker. Furthermore, over 20% received a sodium-glucose cotransporter-2 inhibitor.

Delays in Diagnosis of Patients With CKD in the United States

In another poster, Catterjee et al gathered data from 2009-2020 from Optum Market Clarity to quantify the delays in CKD diagnoses that patients experience in the United States. This retrospective cohort study stratified groups according to whether individuals had comorbid HF or diabetes at baseline. Included individuals had laboratory records exhibiting eGFR under 60 mL/min/1.732. Eligible patients had a second eGFR performed 3-12 months later; their second recorded eGFR under 60 mL/min/1.732 was considered their index date. Participants were followed until their official CKD diagnosis or until death, drop out, or the end of the study period occurred.²

Researchers identified 1.39 million adults with CKD with a mean age of 71 years. Sixty-two percent of these adults were without comorbid HF nor diabetes; 24% had comorbid diabetes; 8% had comorbid HF; and 6% had both comorbidities. Individuals were followed up with for an average of 2.7 years and over 50% had an official CKD diagnosis at follow-up.

Overall, CKD was diagnosed after an average of 469 days. Patients with comorbid diabetes and HF experienced the shortest time period to diagnosis (270 days), while those without either comorbidity experienced the longest delays (537 days).

These results linked the absence of HF or diabetes to longer delay periods alongside reduced CKD severity and younger age. The analysis demonstrated that more severe CKD, the presence of a pre-disposing illness, and racial minorities were associated with an increased likelihood of CKD documentation; however, the study also revealed sex-related differences, with female patients experiencing extended delays of 138 days on average.

When asked about how practitioners can apply this data to reduce diagnostic delays in the future, Satabdi Chatterjee told The American Journal of Managed Care^®, “Up until now, we didn’t even know there was a delay happening... a big goal for the physicians and practitioners will be to understand that [these delays are happening]; then once they see that the patient has their second confirmatory eGFR, that there is no time taken to diagnose [them].”

These posters reinforce the need to both understand CKD and recognize it in the early stages; the findings from these studies give the opportunity to improve the management of CKD and emphasize the added risks when CKD is accompanied by comorbidities. Pollock et al mention that low- and median-income countries endure a higher prevalence of CKD²; therefore, applying the data from these studies could not only benefit approaches to CKD in the US, but globally as well.

References

1. Pollock CA, Khunti K, Heerspink HJL, et al. Clinical characteristics, comorbidities, and management of patients with CKD: insights from iCaReMe Global Registry. Poster presented at: ASN Kidney Week 2023; November 2-5; Philadelphia, PA.

2. Chatterjee S, Levy AR, Donato BM, Zhang L, Stackland S, Kovesdy CP. Quantifying the delay from laboratory-based detection to diagnosis of CKD in the United States. Poster presented at: ASN Kidney Week 2023; November 2-5; Philadelphia, PA.