Robert M. Perkins
Director, US Medical Affairs, Cardiopulmonary Bayer HealthCare Pharmaceuticals, USA
Title: Early Identification and Management of CKD: Opportunities and Unanswered Questions
Biography
Biography: Robert M. Perkins
Abstract
Longitudinal changes in screening and treatment patterns for patients with CKD, and their impact on clinically-relevant outcomes, have not been reported. It is expected that implementation of the 2012 KDIGO chronic kidney disease (CKD) classification system will accelerate the identification of more individuals with earlier stages of CKD compared with the 2002 NKF KDOQI system, based on the addition of ‘high albuminuria’ as a disease-defining criterion.
As with any screening test designed to diagnose a condition or disease, the availability of effective treatments to manage the condition as well as the identification and management of modifiable risk factors among those newly diagnosed are necessary to justify the costs (economic and otherwise) associated with the testing. It is not currently known to what extent modifiable risk factors are present in the population of patients with early CKD.
This report has three objectives. Leveraging a clinical database from a large, integrated health care system, we first evaluated incident (stage G3) CKD patients in 2004-2006, 2007-2009, and 2010-2012 to determine trends in proteinuria screening; treatment (prescription for angiotensin converting enzyme inhibitor or angiotensin receptor blocker, and statin); and nephrology referral. Adjusted rates for mortality, progression to stage G4 CKD, and hospitalization for myocardial infarction or heart failure were calculated and compared across time periods in order to estimate the impact of changes in screening and treatment patterns over this time frame. Second, we compared the risk prediction characteristics of the 2002 NKF and 2012 KDIGO systems using the net reclassification index, for both cardiovascular and renal outcomes. Finally, we aimed to identify the burden of modifiable risk factors among those with ‘preserved’ eGFR but albuminuria in the pathologic range.
The results suggest that more aggressive management of moderate CKD over time has not resulted in improved outcomes over a relatively short follow-up period; that implementation of the 2012 KDIGO CKD classification system improves risk characterization; and that the burden of modifiable risk factors among those with early disease is substantial. Early identification of CKD is therefore feasible and likely clinically important; however, additional research into the impact of early CKD diagnosis and management on clinically relevant outcomes is needed