Chronic Kidney Disease
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Chronic Kidney Disease
An unmet need in chronic kidney disease
Chronic kidney disease (CKD) is an increasingly common and costly public health concern, occurring in just under 10% of individuals worldwide1,2. CKD presents a significant personal and socioeconomic burden as it is progressive, leading to nephron loss, end-stage kidney disease (ESKD) and in some cases, premature death. CKD is increasing in prevalence with an ageing population and a rise in comorbidities, particularly diabetes and hypertension. Diabetic kidney disease (DKD) occurs in around 40% of diabetic patients, and is the most common cause of kidney failure, while hypertension causes around 25% of kidney failure1,3. In low and middle sociodemographic countries, patients who do not die during progression of CKD usually die within months when they reach ESKD due to unavailable renal replacement therapy or inadequate dialysis2. Current treatment strategies for CKD aim to slow down progression; however, they are often implemented too late. Many individuals remain asymptomatic until later stages of disease, with <5% of patients with CKD reporting awareness of their disease4. Earlier diagnosis and management of comorbid conditions associated with CKD onset play an important role in CKD management, alongside strategies for managing CKD directly.
Early chronic kidney disease diagnosis
There is significant variation in the diagnostic methods used to detect CKD5 and simple tests such as urine albumin to creatinine are still not standard practice, even in high income countries2. Further, factors such as age-related structural and functional changes of the kidney, along with comorbidities, often make CKD difficult to recognise and refer, particularly in the elderly. With diagnostic strategies and treatments now widely available for CKD, screening of high-risk individuals and guidance on early diagnosis is critical for effective management and prevention of kidney damage accrual, CKD complications, and ESKD2,6,7. It is essential that the benefits of early CKD diagnosis, risk factors for CKD, and guidance on the available assessment and screening strategies for assessing risk of CKD in different patient settings, are fully understood.
Managing chronic kidney disease
CKD is managed according to stage of disease. At early stages of CKD, management includes lifestyle changes and effective management of comorbid conditions, including hypertension and diabetes. CKD monitoring strategies are also employed to screen for complications of CKD, such as hyperkalaemia, vitamin D deficiency, and secondary hyperparathyroidism, with those at high risk of CKD progression being referred to a nephrologist4. For late-stage CKD (stage 5), dialysis and kidney transplant may be necessary, both presenting very high treatment burdens. A major treatment goal for CKD is to prevent progression to stage 5 kidney disease. An important step in achieving this goal is understanding the importance of managing concordant comorbid conditions in CKD such as diabetes and hypertension, and treatment options for CKD and their utility in different CKD patient groups, to ensure optimal treatment is given for each CKD patient.
Related news and insights
Akebia Therapeutics, Inc. announced that the company received a written response from the Office of New Drugs (OND) of the FDA to Akebia's Formal Dispute Resolution Request (FDRR) regarding the Complete Response Letter (CRL) received in March 2022 for vadadustat
Bayer announced that the Chinese National Medical Products Administration (NMPA) granted marketing authorization for a label extension for Kerendia (finerenone) to include results on cardiovascular (CV) outcomes from the Phase III FIGARO-DKD study.
Akebia Therapeutics, Inc. announced that the Committee for Medicinal Products for Human Use (CHMP) of the European Medicines Agency (EMA) has adopted a positive opinion recommending the European Commission (EC) to approve Vafseo (vadadustat), an oral hypoxia-inducible factor prolyl hydroxylase (HIF-PH) inhibitor for the treatment of symptomatic anaemia associated with chronic kidney disease (CKD) in adults on chronic maintenance dialysis.
In chronic kidney disease, anemia and disordered iron homeostasis are prevalent and associated with significant adverse consequences. In 2012, Kidney Disease: Improving Global Outcomes (KDIGO) issued an anemia guideline for managing the diagnosis, evaluation, and treatment of anemia in chronic kidney disease.
The Asian Pacific society of nephrology HIF-PHI Recommendation Committee, formed by a panel of 11 nephrologists from the Asia-Pacific region who have clinical experience or have been investigators in HIF-PHI studies, reviewed and deliberated on the clinical and preclinical data concerning HIF-PHI.
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- Tuttle KR. SGLT2 inhibition and chronic kidney disease outcomes: in diabetes and beyond. Lancet Diabetes Endocrinol. 2021;9(1):3–5.
- Cockwell P, Fisher L-A. The global burden of chronic kidney disease. Lancet. 2020;395(10225):662–664.
- Alicic RZ, Rooney MT, Tuttle KR. Diabetic Kidney Disease: Challenges, Progress, and Possibilities. Clin J Am Soc Nephrol. 2017;12(12):2032.
- Chen TK, Knicely DH, Grams ME. Chronic Kidney Disease Diagnosis and Management: A Review. JAMA - J Am Med Assoc. 2019;322(13):1294–1304.
- Gheewala PA, Zaidi STR, Jose MD, Bereznicki L, Peterson GM, Castelino RL, et al. Effectiveness of targeted screening for chronic kidney disease in the community setting: a systematic review. J Nephrol. 2018;31(1):27–36.
- Aucella F, Corsonello A, Leosco D, Brunori G, Gesualdo L, Antonelli-Incalzi R. Beyond chronic kidney disease: the diagnosis of Renal Disease in the Elderly as an unmet need. A position paper endorsed by Italian Society of Nephrology (SIN) and Italian Society of Geriatrics and Gerontology (SIGG). J Nephrol. 2019;32(2):165–176.
- Tonelli M, Dickinson JA. Early Detection of CKD: Implications for Low-Income, Middle-Income, and High-Income Countries. J Am Soc Nephrol. 2020;31(9):1931–1940.
- Eddy S, Mariani LH, Kretzler M. Integrated multi-omics approaches to improve classification of chronic kidney disease. Nat Rev Nephrol. 2020;16(11):657–668.