The pressure is on to diagnose and treat chronic kidney disease

insights from industryHelen YehVice PresidentAstraZeneca

In this interview, Helen Yeh, Vice President, BioPharmaceuticals Medical, Cardiovascular, Renal and Metabolism (CVRM) at AstraZeneca, talks to News-Medical about chronic kidney disease (CKD).

What is the burden of chronic kidney disease (CKD)?

For too long, CKD has been neglected as a priority, although it represents a growing global burden on patients, healthcare systems, and society. CKD affects 840 million people worldwide and is expected to become the fifth leading cause of mortality globally by 2040.^1,2

Patients with CKD are at increased risk of cardiovascular (CV) events, poor renal outcomes, and premature death.^3,4,5 This disease can also have profound mental health and quality of life implications as it often disrupts a patient’s daily life and activities, especially when on dialysis – leaving them longing for the time back with their loved ones.⁶

As CKD progresses into later stages, patients may require dialysis or kidney transplantation, which are invasive, time-consuming, and expensive interventions.^7,8 Once CKD progresses to kidney failure, annual costs can amount up to USD 100,000 per patient.⁹ This substantial burden highlights the need for early diagnosis and treatment that can slow disease progression and improve patient outcomes, thus reducing the need for dialysis and other costly late-stage interventions.

Image Credit: AstraZeneca

Who is most at risk for developing CKD?

Several risk factors are common in people who develop CKD, including diabetes, hypertension, and CV disease. Socioeconomic status, ethnicity, and genetics can impact a patient’s risk of developing the disease as well.¹⁰ For example, Asians and African Americans are known to be at higher risk of CKD.^{10, 11,12}

Why is there such a significant unmet need in CKD?

CKD could be called a "silent disease" as many patients do not experience symptoms at earlier stages, making diagnosis more difficult with many patients diagnosed as a consequence of routine testing for other conditions.^{13, 14} As a result, CKD is vastly underdiagnosed and, in fact, an estimated nine out of 10 patients do not know they have it.¹⁰ This often leads to patients being diagnosed only after the disease has already progressed, limiting effective intervention opportunities.

While there are medications available to address some of CKD's associated conditions, few of them work directly to keep the disease from progressing, emphasizing the need not only for new treatment options but earlier testing and diagnosis. ¹⁵

Can CKD be prevented, or progression slowed?

CKD cannot always be prevented, but in some cases, measures can be taken to reduce a patient's risk. For example, effectively managing conditions that could lead to CKD, such as diabetes or high blood pressure, can lower a patient's chances of developing CKD.¹⁶ Diagnosing CKD early when the disease is in its initial stages is also important, as intervening early can slow disease progression, preserve kidney function, and reduce complications.^10,15

At-risk individuals can also make lifestyle changes such as adopting healthier eating habits and quitting smoking to improve their general health and reduce their risk of developing complications such as obesity or CV disease.¹⁶

How can we improve earlier detection and diagnosis?

The first stop for many patients at risk of developing CKD is usually a visit to their primary care physician (PCP). By making testing a regular part of a patient's check-ups, we can improve early detection and diagnosis chances at an early stage.

Regularly checking the estimated glomerular filtration rate (eGFR) on a patient's metabolic panel helps measure the level of kidney function and supports early diagnosis.¹⁸ It is an easy test to integrate as part of a patient's check-up, much like existing screenings for blood pressure, glucose, and cholesterol. Additionally, a simple urine test to check for albuminuria can help detect kidney damage.¹⁰

Through these two simple tests, it is possible to diagnose and understand patients' future risks for CKD. Timely intervention is essential to prevent or slow disease progression, and the tools to do so are readily available.¹⁰

What challenges do PCPs face when diagnosing CKD?

It is never easy to deliver a tough diagnosis that can be life-changing and CKD is no exception. It is critical that we ensure PCPs have adequate information and tools to talk to their patients about CKD. Towards this end, we have launched "The Pressure is On" – a new campaign to raise awareness and empower PCPs to step into their crucial roles in the prevention, diagnosis, and management of CKD. The campaign provides a range of information and patient counseling resources to support physicians in diagnosing and explaining CKD to their patients.

Why should PCPs and patients have conversations about earlier diagnosis?

While patients may not feel CKD symptoms early on, the intraglomerular pressure is building inside their kidneys. If left unchecked, this pressure can cause irreversible damage to nephrons – leading to reduced kidney function, poor outcomes, and, ultimately, lower quality of life. These initial conversations about CKD are the key building blocks for successful early intervention, which has been shown to slow disease progression in CKD patients and reduce the risk of complications.

Where can readers find more information?

We hope PCPs will visit www.diagnose-ckd.com, where a range of resources are available.

About AstraZeneca

Cardiovascular, Renal and Metabolism (CVRM) together forms one of AstraZeneca's three therapy areas and is a key priority area for the Company. By following the science to understand the underlying links between the heart, kidneys, and pancreas more clearly, AstraZeneca is investing in a portfolio of medicines for organ protection and improved outcomes by slowing disease progression, reducing risks, and tackling co-morbidities. The Company's ambition is to modify or halt the natural course of CVRM diseases and potentially regenerate organs and restore function by continuing to deliver transformative science that improves treatment practices and cardiovascular health for millions of patients worldwide.

AstraZeneca (LSE/STO/Nasdaq: AZN) is a global, science-led biopharmaceutical company that focuses on the discovery, development, and commercialization of prescription medicines, primarily for the treatment of diseases in three therapy areas - Oncology, Cardiovascular, Renal & Metabolism, and Respiratory & Immunology. Based in Cambridge, UK, AstraZeneca operates in over 100 countries, and its innovative medicines are used by millions of patients worldwide. Please visit astrazeneca.com and follow the Company on Twitter @AstraZeneca.

About Helen Yeh

Helen Yeh is the Vice President of the CVRM Therapy Area, BioPharmaceuticals Medical, at AstraZeneca. Yeh joined AstraZeneca in 2010 and has served in roles across therapeutic areas, focusing on accelerating the development of the team's medical affairs capabilities. She was appointed to her current role in March 2020 and is responsible for driving growth and innovation for the four inter-related disease areas: metabolic, heart failure, arterial vascular disease, and kidney diseases. She holds a BSc MSc Ph.D. in Pharmacology from the University of Manchester, UK.  

References

1. Jager, Kitty J et al. "A single number for advocacy and communication-worldwide more than 850 million individuals have kidney diseases." Kidney international vol. 96,5 (2019): 1048-1050.   
2. Foreman KJ et al. Forecasting life expectancy, years of life lost, and all-cause and cause-specific mortality for 250 causes of death: reference and alternative scenarios for 2016–40 for 195 countries and territories. Lancet. 2018; 392(10159):2052–90.
3. Ravera M, Noberasco G, Weiss U, et al. CKD awareness and blood pressure control in the primary care hypertensive population. Am J Kidney Dis 2011; 57(1):71–7.
4. Go AS et al. Chronic kidney disease and the risks of death, cardiovascular events, and hospitalization. N Engl J Med 2004; 351:1296–305.
5. Kumar S, Bogle R, Banerjee D. (2014). Why do young people with chronic kidney disease die early?. World journal of nephrology, 3(4), 143–155. https://doi.org/10.5527/wjn.v3.i4.143
6. AstraZeneca. Data on File. REF-87984. 24 September 2020.
7. Centers for Disease Control and Prevention (CDC). Chronic Kidney Disease in the United States, 2019; 11 March 2019. Available from: URL: https://www.cdc.gov/kidneydisease/pdf/Chronic-Kidney-Disease-in-the-US-2021-h.pdf. Accessed March 2021
8. University of California San Francisco. The kidney project. Accessed 17 March 2021. Available from: URL: https://pharm.ucsf.edu/kidney/need/statistics.
9. Levin A et al. Global kidney health 2017 and beyond: a roadmap for closing gaps in care, research, and policy. Lancet 2017; 390(10105):1888–917.
10. National Kidney Foundation. Kidney disease: the basics. Factsheet. Published 14 May 2020. Accessed 11 March 2021. https://www.kidney.org/news/newsroom/factsheets/KidneyDiseaseBasics
11. NIH NIDDK. Race, ethnicity, & kidney disease. March 2014. Accessed 11 March 2021. https://www.niddk.nih.gov/health-information/kidney-disease/race-ethnicity
12. Kataoka-Yahiro M et al. Asian Americans & chronic kidney disease in a nationally representative cohort. BMC  Nephrol 2019; 20(1):10.
13. NIH NIDDK. Kidney disease statistics for the United States. December 2016. Accessed 11 March 2021. https://www.niddk.nih.gov/health-information/health-statistics/kidney-disease
14. NHS. Diagnosis: Chronic kidney disease. August 2019. Accessed 11 March 2021. https://www.nhs.uk/conditions/kidney-disease/diagnosis/.
15. NHS. Treatment: Chronic kidney disease. August 2019. Accessed 11 March 2021. https://www.nhs.uk/conditions/kidney-disease/treatment/.
16. NHS. Prevention: Chronic kidney disease. August 2019. Accessed 11 March 2021. https://www.nhs.uk/conditions/kidney-disease/prevention/.
17. Alabama Department of Public Health. Special Task Force on Chronic Kidney Disease report. Published April 2007. Accessed 11 March 2021. https://www.alabamapublichealth.gov/publications/assets/kidneydiseasereport.pdf.
18. National Kidney Foundation. Estimated glomerular filtration (eGFR). 14 September 2020. Accessed 11 March 2021. https://www.kidney.org/atoz/content/gfr.

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