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The Risk of Undiagnosed CKD In Patients with Type 2 Diabetes

Sep 24, 2019
 
Editor: David L. Joffe, BSPharm, CDE, FACA

Author: Maya Rudolph, Florida A&M University, College of Pharmacy & Pharmaceutical Sciences, PharmD Candidate

Many type 2 diabetes patients have undiagnosed CKD; given its seriousness, both patients and HCPs should be aware of early signs of kidney issues.

Type 2 diabetes has been shown to be the leading cause of chronic kidney disease (CKD). 10-40% of patients with type 2 diabetes will suffer from CKD. Diabetes can cause blood vessels to become injured throughout the body, including the kidneys. CKD is known a progressive condition that occurs when injured blood vessels in the kidney cannot clean blood properly, which can lead to kidney failure or death. Patients with type 2 diabetes with CKD will also experience damaged nerves that cause the body to have difficulty in emptying the bladder, causing the pressure from the bladder to back up in the kidneys. Infections can develop as a result of the bacteria growth in the high glucose concentrated area. This chronic disease is known as the fifth fastest-growing cause of death worldwide. Therefore, it’s important for patients with type 2 diabetes to be knowledgeable on how to control their diabetes, and on early treatment and signs of kidney problems.

 

The Janssen Pharmaceutical Companies of Johnson & Johnson presented the study findings of CKD being undiagnosed in nearly half of patients with type 2 diabetes at the National Kidney Foundation (NKF) 2019 Spring Clinical Meetings in Boston, Mass. The retrospective, observational study assessed 123,000 patients with type 2 diabetes. The data and lab results were collected for the Optum Clinformatics database from January 2010 through September 2017. Eligibility for the study was patients with confirmed type 2 diabetes, less than 85 years of age, with at least 2 lab tests indicating insufficient kidney function. Excluded from the study were:  patients with type 1 diabetes, pregnancy-related diagnosis, gestational diabetes, steroid-induced diabetes, acute kidney injury, polycystic ovary syndrome, renal transplant or those on dialysis. Patients impaired kidney function was measured by two serum creatinine (SCr) measurements, which resulted in an eGFR of <60 mL/min/1.73 m2.

During the study period, CKD diagnosis was identified by the ICD-9/10 codes. Medical claims from 12 months prior to the first eGFR< 60 mL/ min/1.73 m2 to one month after the CKD related diagnoses were examined by researchers. Baseline characteristics also were measured during those preceding 12 months. Undiagnosed CKD was described as without having the following: CKD, T2D with kidney complication, diabetes with renal manifestation, hypertensive CKD, or disorders from impaired renal function.

Most of the undiagnosed patients in stages G3a and G3b CKD had an eGFR of <45-59 mL/min/1.73 m2 and <30-44 mL/min/1.73 m2, respectively. 57% of patients in stage G3a CKD (mild to moderate loss of kidney function) and 29.9 % of patients in stage G3b CKD (moderate to severe loss of kidney) showed no record of CKD diagnosis. Also, no record of CKD was shown for 10.8% of patients in stage G4 CKD (severe loss of kidney function) nor with 4.2% of patients in stage G5 CKD (kidney failure). Northeast and North Central regions of U.S. women between the ages of 55 and 69, were more likely undiagnosed with CKD. Compared to men, women were more prominent in being undiagnosed (52.8 % vs. 44.3%). Patients residing in the Northeast and North Central regions had 97% advantage vs those that resided in the South with 22% odds and in the West with 42% odds. Patients who visited a nephrologist showed lower rates of undiagnosed CKD of 6.5%. In concluding the results, the undiagnosed rate was 49% amongst patients with type 2 diabetes complications that presented as follows: neuropathy (38.6 %) and retinopathy (41.6 %), hypertension (47.9 %), peripheral vascular disease (37.1%) and congestive heart failure (38.7%).

In closing, Paul Burton, M.D., Ph.D., FACC, Vice President, Medical Affairs, Internal Medicine, Janssen Scientific Affairs, LLC, stated that, with type 2 diabetes being on the rise worldwide, Janssen is committed to tackling the challenge to transform lives of millions living with type 2 diabetes and CKD. The importance of educating patients with type 2 diabetes about CKD is vital. Early signs of kidney disease may present in excretion of albumin in urine, which laboratory test can only be done in doctor’s offices or clinical setting. Other early signs may include weight gain, swelling around the ankles, or elevated blood pressure levels. If patients are experiencing any of the following signs, they should contact their doctor.

Practice Pearls:

  • The study showed 49% of patients with type 2 diabetes were undiagnosed with CKD previously by their doctor.
  • The undiagnosed rate of CKD has declined over the years, but the need to educate patients with type 2 diabetes is very important.
  •  Patients with type 2 diabetes should be aware of the severity of CKD.

“Diabetes – A Major Risk Factor for Kidney Disease.” National Kidney Foundation, 3 Feb. 2017, www.kidney.org/atoz/content/diabetes.

“New Study Finds Chronic Kidney Disease Remains Largely Undiagnosed in Nearly Half of Patients with Type 2 Diabetes and Chronic Kidney Disease.” Content Lab – U.S., 10 May 2019, www.jnj.com/new-study-finds-chronic-kidney-disease-remains-largely-undiagnosed-in-nearly-half-of-patients-with-type-2-diabetes-and-chronic-kidney-disease.

Maya Rudolph, Florida A&M University, College of Pharmacy & Pharmaceutical Sciences, PharmD Candidate