Geographical variation in kidney function testing and associations with health care costs among patients with chronic kidney disease and type 2 diabetes

Betts, Keith A.; Song, Jinlin; Elliott, Jay C.; Warnock, Neil D.; Farej, Ryan; Wu, Aozhou; Singh, Rakesh

doi:10.37765/ajmc.2022.89211

Cited by 3 publications

(3 citation statements)

References 19 publications

(26 reference statements)

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“…Yet, several studies from primary-care practices showed the underutilization of tests, inadequate recognition, and undercoding of CKD patients, even in those with high-risk conditions (16,(23)(24)(25)(42)(43)(44). In the CURE-CKD registry, nearly one half of patients with persistently low eGFR remained undiagnosed in 2014-2017 (22).…”

Section: Discussionmentioning

confidence: 99%

“…In recent years, considerable efforts have been made to increase the awareness of CKD, to timely detect and deliver proper care to identified CKD patients. CKD is still often under-detected, even amongst patients with high-risk conditions (e.g., DM, hypertension, or CVD) (22)(23)(24)(25), where screening for CKD is recommended by regularly testing eGFR and albuminuria (10,21,26).…”

Section: Introductionmentioning

confidence: 99%

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Prevalence, Cardiometabolic Comorbidities and Reporting of Chronic Kidney Disease; A Hungarian Cohort Analysis

Zemplényi¹,

Sághy²,

Kónyi³

et al. 2023

Int J Public Health

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Objectives: Chronic kidney disease (CKD) implies increased comorbidity burden, disability, and mortality, becoming a significant public health problem worldwide, however, prevalence data are lacking in Hungary.Methods: We determined CKD prevalence, stage distribution, comorbidities using estimated glomerular filtration rate (eGFR), albuminuria, and international disease codes in a cohort of healthcare utilizing residents within the catchment area of the University of Pécs, in the County Baranya, Hungary, between 2011 and 2019 by database analysis. The number of laboratory-confirmed and diagnosis-coded CKD patients were compared.Results: Of the total 296,781 subjects of the region, 31.3% had eGFR tests and 6.4% had albuminuria measurements, of whom we identified 13,596 CKD patients (14.0%) based on laboratory thresholds. Distribution by eGFR was presented (G3a: 70%, G3b: 22%, G4: 6%, G5: 2%). Amongst all CKD patients 70.2% had hypertension, 41.5% diabetes, 20.5% heart failure, 9.4% myocardial infarction, 10.5% stroke. Only 28.6% of laboratory-confirmed cases were diagnosis-coded for CKD in 2011–2019.Conclusion: CKD prevalence was 14.0% in a Hungarian subpopulation of healthcare-utilizing subjects in 2011–2019, and substantial under-reporting of CKD was also found.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Prevalence, Cardiometabolic Comorbidities and Reporting of Chronic Kidney Disease; A Hungarian Cohort Analysis

Zemplényi¹,

Sághy²,

Kónyi³

et al. 2023

Int J Public Health

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“…This lack of knowledge can hinder the diagnosis of early CKD, as well as an appropriate risk stratification of patients. Other barriers include the limited involvement of primary care in management of CKD, a lack of proper nephrology consults based on target GFR and lack of clinician- or patient-targeted evidence-based interventions to reduce CKD progression or CVD, the existence of few partnerships between a clinician and patient, and insufficient tools for utilizing electronic health records (EHRs) [ 11 , 12 , 67 , 68 , 69 ].…”

Section: Overcoming Barriers To Ckd Care Deliverymentioning

confidence: 99%

Optimizing Care Delivery in Patients with Chronic Kidney Disease in the United States: Proceedings of a Multidisciplinary Roundtable Discussion and Literature Review

Hirsch,

Danna,

Desai

et al. 2024

JCM

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Background: Approximately 37 million individuals in the United States (US) have chronic kidney disease (CKD). Patients with CKD have a substantial morbidity and mortality, which contributes to a huge economic burden to the healthcare system. A limited number of clinical pathways or defined workflows exist for CKD care delivery in the US, primarily due to a lower prioritization of CKD care within health systems compared with other areas (e.g., cardiovascular disease [CVD], cancer screening). CKD is a public health crisis and by the year 2040, CKD will become the fifth leading cause of years of life lost. It is therefore critical to address these challenges to improve outcomes in patients with CKD. Methods: The CKD Leaders Network conducted a virtual, 3 h, multidisciplinary roundtable discussion with eight subject-matter experts to better understand key factors impacting CKD care delivery and barriers across the US. A premeeting survey identified topics for discussion covering the screening, diagnosis, risk stratification, and management of CKD across the care continuum. Findings from this roundtable are summarized and presented herein. Results: Universal challenges exist across health systems, including a lack of awareness amongst providers and patients, constrained care team bandwidth, inadequate financial incentives for early CKD identification, non-standardized diagnostic classification and triage processes, and non-centralized patient information. Proposed solutions include highlighting immediate and long-term financial implications linked with failure to identify and address at-risk individuals, identifying and managing early-stage CKD, enhancing efforts to support guideline-based education for providers and patients, and capitalizing on next-generation solutions. Conclusions: Payers and other industry stakeholders have opportunities to contribute to optimal CKD care delivery. Beyond addressing the inadequacies that currently exist, actionable tactics can be implemented into clinical practice to improve clinical outcomes in patients at risk for or diagnosed with CKD in the US.

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Barriers to early diagnosis of chronic kidney disease and use of sodium‐glucose cotransporter‐2 inhibitors for renal protection: A comprehensive review and call to action

Czupryniak,

Mosenzon,

Rychlík

et al. 2024

Diabetes Obesity Metabolism

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Chronic kidney disease (CKD) affects approximately 13% of people globally, including 20%–48% with type 2 diabetes (T2D), resulting in significant morbidity, mortality, and healthcare costs. There is an urgent need to increase early screening and intervention for CKD. We are experts in diabetology and nephrology in Central Europe and Israel. Herein, we review evidence supporting the use of sodium‐glucose cotransporter‐2 (SGLT2) inhibitors for kidney protection and discuss barriers to early CKD diagnosis and treatment, including in our respective countries. SGLT2 inhibitors exert cardiorenal protective effects, demonstrated in the renal outcomes trials (EMPA‐KIDNEY, DAPA‐CKD, CREDENCE) of empagliflozin, dapagliflozin, and canagliflozin in patients with CKD. EMPA‐KIDNEY demonstrated cardiorenal efficacy across the broadest renal range, regardless of T2D status. Renoprotective evidence also comes from large real‐world studies. International guidelines recommend first‐line SGLT2 inhibitors for patients with T2D and estimated glomerular filtration rate (eGFR) ≥20 mL/min/1.73 m2, and that glucagon‐like peptide‐1 receptor agonists may also be administered if required for additional glucose control. Although these guidelines recommend at least annual eGFR and urine albumin‐to‐creatinine ratio screening for patients with T2D, observational studies suggest that only half are screened. Diagnosis is hampered by asymptomatic early CKD and under‐recognition among patients with T2D and clinicians, including limited knowledge/use of guidelines and resources. Based on our experience and on the literature, we recommend robust screening programmes, potentially with albuminuria self‐testing, and SGLT2 inhibitor reimbursement at general practitioner (GP) and specialist levels. High‐tech tools (artificial intelligence, smartphone apps, etc.) are providing exciting opportunities to identify high‐risk individuals, self‐screen, detect abnormalities in images, and assist with prescribing and treatment adherence. Better education is also needed, alongside provision of concise guidelines, enabling GPs to identify who would benefit from early initiation of renoprotective therapy; although, regardless of current renal function, cardiorenal protection is provided by SGLT2 inhibitor therapy.

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Geographical variation in kidney function testing and associations with health care costs among patients with chronic kidney disease and type 2 diabetes

Abstract: S105VALIDATION OF THE FINE-CKD MODEL placebo. 8 Based on the FIDELITY results, on top of the maximum tolerated renin-angiotensin system inhibitor (RASi) treatment, finerenone showed substantial benefits for a range of CV and renal outcomes. 11

Cited by 3 publications

References 19 publications

Prevalence, Cardiometabolic Comorbidities and Reporting of Chronic Kidney Disease; A Hungarian Cohort Analysis

Prevalence, Cardiometabolic Comorbidities and Reporting of Chronic Kidney Disease; A Hungarian Cohort Analysis

Optimizing Care Delivery in Patients with Chronic Kidney Disease in the United States: Proceedings of a Multidisciplinary Roundtable Discussion and Literature Review

Barriers to early diagnosis of chronic kidney disease and use of sodium‐glucose cotransporter‐2 inhibitors for renal protection: A comprehensive review and call to action

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