Currently, about 37 million adults across the United States are living with chronic kidney disease (CKD). By the CDC’s estimate, this is about 15% of all adults in the country. Yet, by that same estimate, as many as 9 in 10 adults with CKD do not know they have it, as CKD can be harder to detect in its early stages.[i]
Oftentimes, symptoms do not manifest in those affected until the kidneys are badly damaged or their kidney disease is advanced. This means that without screening, patients with CKD may remain under or improperly diagnosed until their condition has worsened significantly, negatively impacting their treatment and care.
Of the two tests recommended by the National Kidney Foundation to screen for, diagnose, and manage CKD[ii], recent studies show high levels of estimated glomerular filtration rate testing (to evaluate kidney function), but low levels of urine albumin-to-creatinine ratio testing (to evaluate kidney damage), suggesting physicians are inconsistently adhering to guideline recommendations.[iii] This is particularly prevalent in patients with diabetes, who are at a higher risk for kidney disease or failure.[iv]
Additionally, data suggests many patients at risk are not being screened at all during early stages when treatment can slow down the progression of disease and reduce unfavorable outcomes like dialysis and transplant due to kidney failure. In fact, recent reports show prevention, recognition, and treatment strategies for CKD are greatly underutilized overall.[v] Furthermore, data also shows one in four patients “crash” into dialysis.[vi]
Benefits of Earlier Screening & Treatment
Taking steps to improve an at-risk patient’s health before drastic measures like dialysis or transplant are necessary is important in providing the best care. The question is, what should the medical community do differently to close gaps in screening to diagnose more patients in the early and more easily treatable stages of CKD?
Across the board, many understand the importance of screening and treating early as a tool to both improve outcomes and, ultimately, lower care costs for patients and providers. Recent shifts, like the new guidelines introduced by the US Preventive Services Task Force (USPSTF) and the American Diabetes Association, which lowered the age to screen for prediabetes and type 2 diabetes to 35[vii], are now emphasizing the importance of tools like screening to identify patients sooner.
Indeed, researchers estimate that the new guidelines will increase the proportion of asymptomatic US adults eligible for screening by about 6%-7%, equating to approximately twice as many individuals.[viii] Ultimately, this may increase positive outcomes for patients who will now be able to be treated sooner, before their diabetes progresses to a comorbidity of another condition, which could worsen into serious complications down the line.
Severe CKD is one of many conditions wherein the outcome for the patient can change drastically if it is diagnosed and treated sooner. At Quest Diagnostics, my colleagues and I have been working to close gaps in screening and treatment through several important channels, primarily by utilizing population management tools to help identify patients earlier to allow for intervention in the beginning stages of disease progression. We work with health plans to find hidden disease and risk-stratify patient populations, leveraging data and analytics to help identify the patient populations at highest risk for CKD and arm their physicians with vital educational content.
Tools for Managing CKD and Working With Those At Risk
For those patients that will need renal replacement therapies or dialysis, Quest has programs that can help predict the timing to allow for peritoneal (vs catheter) dialysis starts and lead time for transplant consideration. Utilizing these tools can ultimately lead to a potential delay in dialysis and better QOL for each patient, as well as a possible reduction in the costs of care. Additionally, we cannot undercut the importance of meeting patients where they are using low-friction, patient engagement programs to help patients understand and manage CKD risk, as well as provide education and guidance in making lifestyle modifications to limit CKD progression.
Finally, we have also introduced key programs to increase comprehension of the issues at work, including physician education and enhanced reporting tools for our tests. As an example, the Quest Kidney Profile with Enhanced Reporting supports the National Kidney Foundation’s initiative to drive adoption, and facilitate appropriate ordering, of the elements needed for early detection.
Taking a prevention-focused approach with at-risk patients, including those with diabetes and high blood pressure, is the best tool we have to deliver better care. However, the progression of the COVID-19 pandemic has made it challenging to ensure individuals receive the care they need. Many patients are only now getting back to care after delaying in-person medical visits for fear of COVID-19. We have seen the effects these delayed appointments can cause; cancer diagnoses declined sharply during the pandemic[ix], and other chronic conditions like CKD may follow the same trend. When early detection is so vital to treating these conditions, delayed care can be problematic.
Physicians cannot afford to ignore this important issue. They can and should collaborate with health plans to increase access to screenings and educational tools, to reach and drastically improve outcomes for the patients most in need of intervention. Lack of adherence to guidelines can cause longstanding effects for patient populations, so it is critical that physicians take advantage of the tools at their disposal to ensure these tests are utilized as recommended.