Conference Coverage

Monitoring limited in stage 3 chronic kidney disease



Fewer than a quarter of patients with signs of stage 3 chronic kidney disease (CKD) underwent follow-up testing within 1 year, even though most of these patients underwent repeat cholesterol screening during the same time.

Dr. Barbara S. Gillespie of Covance, the drug development business of LabCorp

Dr. Barbara S. Gillespie

Considering that CKD can be asymptomatic until the late stages, “this is a lost opportunity to get a proper evaluation by a nephrologist,” study coauthor and nephrologist Barbara S. Gillespie, MD, MMS, of Covance, the drug development business of LabCorp, said in an interview. Dr. Gillespie and her colleagues presented their findings at Kidney Week 2018, sponsored by the American Society of Nephrology.

More than 90% of patients with stages 1-3 CKD didn’t know they had the condition, based on 2013-2016 data gathered by the United States Renal Data System . Just 57% of those with stage 4 CKD were aware of their disease.

For the retrospective study, the researchers identified 4.9 million patients (58% were women; mean age was 71) who had estimated glomerular filtration rate (eGFR) results below 60 mL/min per 1.73 m2 from 2011 to 2018, based on serum creatinine tests performed at least twice and at least 3 months apart by LabCorp. The researchers tracked the patients for a median 26 months.

Based on the initial results, 92% of the patients had stage 3 CKD, 6% had stage 4, and 2% had stage 5. However, at 1 year, the percentages of overall patients who underwent urine albumin/creatinine ratio, serum phosphorus, and plasma parathyroid hormone were 24%, 12%, and 17%, respectively, lead author Jennifer Ennis, MD, of LabCorp, said in an interview.

Kidney Disease Improving Global Outcomes guidelines from 2012 recommend “assessments of GFR and albuminuria at least annually ... and more often for individuals at higher risk of progression, and/or where measurement will impact therapeutic decisions” (Ann Intern Med. 2013 Jun 4;158[11]:825-30).

Yet 76% of these patients also underwent annual LDL cholesterol screening. “This suggests that the patients were receiving evaluation and treatment for other common conditions, but that CKD may not have been specifically addressed,” Dr. Ennis said.

Dr. Jennifer Ennis, LabCorp

Dr. Jennifer Ennis

“These results suggest that guideline recommendations for monitoring of CKD are not well implemented in the primary care setting, which is where the majority of this testing took place,” she added. “There are possibly many reasons for this, including lack of guideline awareness, familiarity, or agreement; inertia; or other external barriers such as time constraints and the burden of having to remember numerous guidelines for a single patient with multiple conditions.”

Dr. Gillespie said the findings may help to explain why so many patients with CKD are unaware of their condition and “crash into dialysis” within 24 hours of winding up in the emergency department with kidney failure. “Often they note they did not know they had kidney disease,” she said, “or did not know how bad it was.”

The authors disclosed employment by LabCorp, which funded the study.

SOURCE: Ennis JL et al. Kidney Week 2018, Abstract PUB111.

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