The United States Preventive Services Task Force met to discuss whether it should advise all Americans to get screened for kidney disease. Its supporters had been pressing for it, pointing to the exponential growth of chronic renal disease. But at the time, the team concluded that there wasn't enough data to determine if screening was beneficial overall. This was back in 2012.
"Chronic kidney disease is often clinically silent until patients reaches late-stage kidney disease, so many people with early-stage CKD are unaware they have it," said Marika Cusick, a PhD candidate in health policy at Stanford Medicine and the research's main author, who was also the paper's first author. The study was published in the Annals of Internal Medicine. "By screening for CKD, we can diagnose and treat it at an earlier stage, improving life expectancy and lowering the chance of progressing to late-stage kidney disease, which is fatal and expensive." -Marika Cusick
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| Marika Cusick, a PhD candidate Health policy at Stanford Medicine |
Approximately 37 million Americans, or 15% of adult Americans, have chronic renal disease. Two-thirds of cases are caused by excessive blood pressure and diabetes. Medicare spends $87 billion yearly on CKD, with $37 billion going on kidney replacement therapy.
The progression of kidney disease has been discovered to be slowed by a novel family of medications known as sodium-glucose cotransporter-2 inhibitors. The debate over whether screening for early-stage CKD improves clinical outcomes was altered by these medications, which are used to treat Type 2 diabetes and were authorized by the Food and Drug Administration roughly 10 years ago.
(Albuminuria, or the presence of the protein albumin in the urine, is checked as part of the CKD screening process. Kidney disease is indicated by its presence in urine)
Data from the National Health and Nutrition Examination Survey, an annual survey conducted by the National Center for Health Statistics to evaluate the health of around 5,000 adults and children in the United States, were utilized by the researchers for their study.
They then extended their findings to the whole adult population of the United States, aged 35 and older, and performed a cost-effectiveness analysis of albuminuria screening with and without SGLT2 inhibitors in comparison to the current standard of treatment for CKD.
Although SGLT2 inhibitors were first used to treat persons with type 2 diabetes, studies revealed that they also slowed the decline of kidney function in those without diabetes. Among this family of medications, which also includes canagliflozin and dapagliflozin, empagliflozin, sold under the brand name Jardiance, is one of the more well-known. The introduction of SGLT2 inhibitors represents a "breakthrough in nephrology," according to Gregorio Obrador, a professor and nephrologist at the Universidad Panamericana who has researched the early diagnosis of CKD in Mexico.
Cusick started researching the return on investment when dapagliflozin, a medication frequently used to manage high blood sugar, was introduced to the standard of care for persons with non-diabetic chronic renal disease. She found it to be economical.
Then, she inquired as to whether population-wide screening for chronic kidney disease using an albumin-detection urine test would be cost-effective in addition to SGLT2 inhibitor therapy.
Study Discoveries
They discovered that a one-time test and the usage of SGLT2 inhibitors might prevent approximately 400,000 people from having dialysis or a kidney transplant in their lifetime by using current data and a model to extrapolate results to the whole U.S. population.
Comparative to the current situation, screening every five years combined with SGLT2 inhibitors might keep 658,000 patients from having a transplant or dialysis. While more frequent screening for those aged 55 to 65 would be desirable given the increase in CKD prevalence in that age group, screening every ten years is "good value" for those 35 to 45 years.
When one considers the enormous financial burden of end-stage kidney disease in the U.S., the results based there make sense, according to Cusick. Medicare spends $87 billion annually on treating chronic kidney disease, and an additional $37 billion on providing treatment for patients who have renal failure, are receiving dialysis, or require a kidney transplant.
The cost of later-stage treatment is high for the healthcare system. Early identification and treatment might prevent significant expenses down the line, as well as perhaps saving lives, given that an estimated 90% of people with chronic kidney disease are unaware they have it because the disease is asymptomatic until later stages.
People who are thought to be at high risk for chronic kidney disease, such as those with diabetes, high blood pressure, or a family history of the condition, can be screened in other nations, such as Mexico. The USPSTF resumed kidney disease screening in January.
The panel will evaluate the information at hand, listen to the public, and make a decision about whether population-level CKD screening is likely to be advantageous over the course of several years. As with every screening, there is a chance for damage, including false positive results, patients receiving pointless, costly, or hazardous diagnostic tests, treatments, or therapies.
Conclusion
Cusick expressed her desire for the group's decision-making to include her work. The study she conducted indicates that using SGLT2 inhibitors and doing countrywide screening might have more positive effects than negative ones. The cost-effectiveness of SGLT2 inhibitors depends on their being both reasonably priced and demonstrating efficacy in lowering all-cause mortality and delaying the course of CKD, which is a significant caveat.
The effectiveness of this class of medications in slowing the course of kidney disease has been demonstrated in short-term studies, but longer-term research is necessary to determine how effective these medications are in everyday situations. The quantity of data that the researchers had to work with also placed restrictions on their findings, so when more data becomes accessible, it should be easier to determine if a certain strategy is cost-effective.
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