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CKD in T2D organ damage

UACR Testing + Organ Damage

EARLY, COMPREHENSIVE TESTING CAN HELP IDENTIFY CKD PROGRESSION1

Patients with CKD in T2D are most commonly referred to a nephrologist at stage 3 CKD or later.

Guidelines state, all patients should have their eGFR and UACR monitored annually—even as early as CKD stage 1.1,2

For CKD in T2D, there are 2 main tests that are used to determine how well the kidneys are functioning:

Estimated glomerular filtration rate

Estimated glomerular filtration rate (eGFR)1

  • Measures how much creatinine (a waste product from kidney filtration) is in the blood
  • Is a more reliable indicator of later-stage kidney damage
  • Reveals worsening kidney function when eGFR levels decline
  • A patient is typically diagnosed with CKD when their eGFR falls below 60 mL/min/1.73m2
Urine albumin-to-creatinine ratio

Urine albumin-to-creatinine ratio (UACR)3,4

  • Measures how much albumin (a waste protein) is in the urine and puts it in a ratio to the level of creatinine
  • Is a more sensitive measure of kidney damage, especially earlier-stage kidney damage
  • Reveals if increased levels of albumin are in the urine
    • High albuminuria (30-300 mg/g)
    • Very high albuminuria (>300 mg/g)
  • Unlike eGFR, UACR demonstrates a linear relationship with CV mortality and can be used to estimate CV risk

CKD PROGRESSION DAMAGES MORE THAN THE KIDNEYS

Without addressing inflammation and fibrosis in kidneys, there is still a residual risk of CKD progression.

CKD in T2D increases CV death by 3x

Over a 10-year period, patients with CKD in T2D were 3 times more likely to die of CV-related causes than patients with T2D alone5*

60% of CKD patients have CVD

More than 60% of CKD patients develop CVD6

*A survey examining the all-cause mortality of patients with CKD and/or T2D in the US (N=15,046).

CKD: chronic kidney disease; CV: cardiovascular; CVD: CV disease; T2D: type 2 diabetes.

CKD in T2D, also known as diabetic kidney disease or diabetic nephropathy, may be centered in the kidneys, but kidney health has far-reaching implications for the rest of the body as well—especially CV events. As evidenced by the high rate of CV mortality in patients with CKD in T2D, the cardiovascular and renal systems have a close relationship. As the 3 drivers of progression contribute to further kidney damage, the risk of a CV event also increases.1,7

CKD has important kidney and CV implications8

Kidney damage image

Kidney damage

  • Glomerular hypertrophy
  • Renal vascular damage
  • Kidney injury
  • Reduced blood flow
Cardiac damage Image

Cardiovascular damage

  • Left ventricular hypertrophy
  • Arrhythmia
  • Cardiomyopathy
  • Reduced blood flow

CV events are a major risk for patients WITH CKD in T2D5,6

Patients with CKD are 6 times more likely to die from a CV cause than develop ESKD. That risk increases as CKD progresses and the kidneys become further impaired. That’s why early detection of CKD in T2D is the first step towards slowing down CKD progression and preventing harmful CV outcomes.5

Patients with high albuminuria (>30 mg/g) are 1.5 times more likely to die from CV events compared to patients with normal levels of albumin

These events include myocardial infarction, heart failure, sudden cardiac death, or stroke—and this risk is independent of eGFR.4

The damage to the kidney caused by CKD in T2D can occur at a cellular level, affecting the CV system before eGFR tests uncover an issue with kidney function. Yet less than half of patients with CKD in T2D are tested annually for albuminuria, as recommended by the American Diabetes Association and the National Kidney Foundation.3,9-11

The chart below shows how the 2 tests, when used together, can determine the risk of progression to ESKD. It can be used when you suspect kidney damage and CV risk are increasing in patients with CKD in T2D.1

When leveraged together, increasing levels of albuminuria and reduced rates of eGFR indicate clinical manifestations of kidney damage1

Chart of chronic kidney disease stages with increasing renal and cardiovascular risk

Blue: low risk of CKD progression, with GFR and UACR measurements recommended annually if CKD is present; yellow: mild risk of CKD progression, with GFR and UACR measurements recommended at least once per year; orange: moderate risk of CKD progression, with GFR and UACR measurements recommended twice per year; red: high risk of CKD progression, with GFR and UACR measurements recommended 3 times per year; deep red: very high risk of CKD progression, with GFR and UACR measurements recommended 4+ times per year. Based on recommended guidelines.

 

Reprinted from Kidney Int Suppl, Vol 3 /Issue 1, Kidney Disease: Improving Global Outcomes (KDIGO) CKD Work Group, KDIGO 2012 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease / Chapter 2: Definition, identification, and prediction of CKD progression, Page 63, Copyright (2013), with permission from Elsevier.

 

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References:

  • Kidney Disease Improved Global Outcomes Committee. Kidney Int. 2013;3(1):1-150.
  • Sprangers B, Evenepoel P, Vanrenterghem Y. Mayo Clin Proc. 2006;81(11):1487-1494.
  • Campion CG, Sanchez-Ferras O, Batchu SN. Can J Kidney Health Dis. 2017;4:2054358117705371.
  • Van der Velde M, Matsushita K, Coresh J, et al. Kidney Int. 2011;79(12):1341-1352.
  • Afkarian M, Sachs MC, Kestenbaum B, et al. J Am Soc Nephrol. 2013;24(2):302–308.
  • Schefold JC, Filippatos G, Hasenfuss G, Anker SD, von Haehling S. Nat Rev Nephrol. 2016;12(10):610-623.
  • National Institute of Diabetes and Digestive and Kidney Diseases. Diabetic Kidney Disease. National Institutes of Health. Updated February 2017. Accessed September 16, 2020. https://www.niddk.nih.gov/health-information/diabetes/overview/preventing-problems/diabetic-kidney-disease.
  • Bauersachs J, Jaisser F, Toto R. Hypertension. 2015;65(2):257-63.
  • American Diabetes Association. Diabetes Care. 2019;42(Suppl 1):S184–S186.
  • National Kidney Foundation. Am J Kidney Dis. 2007;49(2 Suppl 2):S12-S154.
  • United States Renal Data System. Bethesda, MD; 2018.