Underdiagnosis of chronic kidney disease?

A research program with real-life data developed in Spain by AstraZeneca has shown that chronic kidney disease is present in the 30 percent of patients with analyzes recorded in Primary Care centers and reference hospitals in the country included in the BIG-PAC database.

The data, published in the magazine Nephrology and presented at the 55th Congress of the Spanish Society of Nephrology, has shown that As chronic kidney disease progresses, associated cardiovascular and renal complications also increase..

“About 30 percent of patients with blood and urine tests recorded in the electronic medical records had chronic kidney disease. This figure is significantly higher than the prevalence previously reported in Spanish studies in recent years,” detailed the main author of the research, Dr. Rafael Santamaría.

Likewise, scientists have observed a “very high” use of health resources, among which hospitalizations concentrate the majority of them and determine a high cost.

All of this shows “for the first time” a comprehensive vision of the magnitude and impact of this pathology on the health system. Despite this, it has been observed that the management of the disease and the treatments recommended in the clinical practice guidelines (KDIGO) are not optimized.

“The results, therefore, are a wake-up call: chronic kidney disease could be underdiagnosed (…) The message we extract is that detecting earlier, treating better and optimal coordination translates into fewer hospitalizations, less costs and more quality life“warned Santamaría, a nephrologist at the Reina Sofía University Hospital in Córdoba.

Because this pathology may not cause symptoms in its early stages, the specialist has stressed the importance of establishing systematic screening in Primary Care of risk groups, such as the population suffering from diabetes, hypertension, cardiovascular diseases, obesity, or the elderly.

The study has also analyzed the annual use of resources and health costs per patient for two years, with conclusions that suggest that the annual costs per patient during the first year can range between 1,500 and 20,500 eurosdepending on the stage of albuminuria, with hospitalizations being the main driver of the total cost.

The categories of kidney damage but with almost normal function have predominant costs related to pharmacy and emergency expenses; in moderate-mild and moderate-severe kidney damage, pharmacy and hospitalizations have a similar weight; in severe kidney damage and near-total or terminal kidney failurethe costs of hospitalizations “clearly” exceed the costs of medication.

“Hospitalization is the great driver of spending. Every admission that we avoid with early detection and cardiorenal therapy is a saving for the system, and an improvement for patients,” said Dr. Santamaría.

It should be noted that national projections estimate that chronic kidney disease will represent 5.56 percent of public health spending in 2027compared to 4.88 percent in 2022, with 42.5 percent directly linked to renal replacement treatment.

“Preventing the progression of the disease is more cost-effective than financing the terminal phase. Every euro invested in early detection, risk control and therapies with kidney protection avoids the costs of hospitalizations and dialysis. CKD is the perfect example of ‘paying for value’,” concluded Santamaría.

The study, of an observational, retrospective nature and based on real-life data from seven autonomous communities, has analyzed a population of 70,385 people with at least one measurement of the estimated glomerular filtration rate (eGFR) and albuminuria in the predefined observation period.