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CKD flying under the radar in T2D patients
TITUSVILLE, NJ—The Janssen Pharmaceutical Companies of Johnson & Johnson just announced the results of a new retrospective, observational study. The data show that 49 percent of patients with type 2 diabetes (T2D) and lab-confirmed chronic kidney disease (CKD) didn’t have a CKD diagnosis from their doctor in a claims database. The 123,000-patient study, entitled “Prevalence and Factors Associated with Undiagnosed Chronic Kidney Disease in Diabetes Mellitus,” was presented at the National Kidney Foundation 2019 Spring Clinical Meetings in Boston, Mass.
CKD is a progressive condition which occurs when damaged kidneys can’t properly filter blood, and it often leads to kidney failure. This affects 10 percent of the world population, and is the fifth fastest-growing cause of death around the world. Type 2 diabetes is the leading cause of CKD, and there have been no new medicines created to treat or prevent CKD in more than 17 years. Worldwide, 160 million people with T2D are at risk for developing CKD. The study underscores the need for increased education focused on diagnosing and treating patients with T2D and CKD.
“About one in three people with T2D have CKD, so it’s important to look for it in its early stages. We found that nearly half of the patients we studied with T2D and CKD had no CKD diagnosis, even when their labs confirmed the presence of CKD. While the undiagnosed CKD rate declined over time, there is still a clear and urgent need for education and detection of this serious and potentially life-threatening complication,” said lead study investigator George Bakris, M.D., professor of medicine and director, Comprehensive Hypertension Center, University of Chicago.
Researchers also found that patients in stage G3a and G3b CKD, defined as having an estimated glomerular filtration rate (eGFR) of <45-59 mL/min/1.73 m2 and <30-44 mL/min/1.73 m2, respectively, were the most undiagnosed. Specifically, 57.1 percent of patients with stage G3a and 29.9 percent with stage G3b had no record of CKD diagnosis. Of those with severe loss of kidney function (stage G4) and kidney failure (stage G5), 10.8 percent and 4.2 percent, respectively, had no record of CKD diagnosis.
Women, people between 55 and 69 years old, and those who reside in the Northeast and North Central regions of the U.S. were more likely to be undiagnosed with CKD. Women had 41 percent higher odds of being undiagnosed, compared to men (52.8 percent vs. 44.3 percent). Relative to patients who were 70-74 years old, those who were 55-64 and 65-69 years old had 36 percent and 13 percent higher odds of being undiagnosed, respectively, while those who were 75-79 and 80-84 years old had 10 percent and 17 percent lower odds. As compared with patients in the South, those living in the Northeast and North Central regions of the U.S. had 97 percent and 22 percent higher odds of being undiagnosed, respectively, while patients in the West had 42 percent lower odds.
Patients who visited a nephrologist, had complications related to T2D or had specific cardiovascular comorbidities had lower rates of undiagnosed CKD. The undiagnosed rate was 6.5 percent among patients who visited a nephrologist. The undiagnosed rate was below 50 percent among patients with T2D complications, including neuropathy (38.6 percent) and retinopathy (41.6 percent), as well as those with specific cardiovascular comorbidities including hypertension (47.9 percent), peripheral vascular disease (37.1 percent) and congestive heart failure (38.7 percent).
The availability of ACR (albumin-to-creatinine ratio), a urine test to assess kidney function, was a factor independently related to lower odds of undiagnosed CKD. And the undiagnosed CKD rate has declined over time, from 56.3 percent in 2011 to 40.3 percent in 2017.
“With the prevalence of T2D continuing to rise globally, CKD has become one of the most serious health challenges we face today,” added Paul Burton, M.D., Ph.D., FACC, vice president, Medical Affairs, Internal Medicine, Janssen Scientific Affairs. “While there is no cure for CKD, recent research has shown it may be possible to prevent or delay its progression. Janssen remains committed to tackling this challenge, and we believe the work we’re doing has the potential to transform the lives of millions of people living with T2D and CKD.”