Among the common diseases, it leads a shadowy existence: Chronic kidney disease (CKD), often referred to as kidney failure. An estimated 9 million people in Germany suffer from it – and the number is likely higher. Treatment options are excellent, but since hardly anyone is tested, they don't reach the people. Read the interview with Dr. Michael Seewald, Medical Director at the research-based pharmaceutical company AstraZeneca, about missed opportunities.
9 million CKD sufferers, and likely more. And at the same time, an abysmal diagnosis rate…
Dr. Michael Seewald: Yes, that is a dramatically high number, and it's increasing: By 2027, it could already be 11 million. In reality, only about 10 percent of affected CKD patients are diagnosed.
Why is that? What are the hurdles?
Seewald: CKD patients initially have hardly any symptoms. This is one of those diseases that is very quiet and inconspicuous at first – there's little that could set off an alarm. When we look at the medical side, we actually have a relatively clear picture of what constitutes a patient at risk – these are people with high blood pressure, diabetes, metabolic syndrome, obesity, or who smoke. But I fear that the past opinion is still ingrained that there's not much that can be done anyway. The idea of specifically testing for kidney disease doesn't arise because successful treatment has only been possible for a few years.
How complex is testing for CKD?
Seewald: Not at all. With the eGFR, a blood test, we can determine the filtration rate of the kidneys; in other words, we can see how well they are functioning. With the UACR, a urine test, we measure the amount of protein excreted by the kidneys. In healthy kidneys, this is practically zero. Medical guidelines recommend systematic testing of risk groups. The reality is different.
Namely?
Seewald: At least the filtration rate is measured in 46.5 percent of at-risk patients, but less than 1 percent receive the urine test. This was revealed by the InspeCKD study – and this is a problem: The urine test for the protein albumin is a much more sensitive indicator of kidney damage; it therefore allows for a diagnosis at a time when the eGFR might still show normal values.
So, I only get a clear picture of my kidney's condition with both tests?
Seewald: Exactly. And that's why it's so tragic. The eGFR can say: The kidney is okay, even though the equally inexpensive and fast UACR test would show me that the kidney is damaged. I only get a clear statement with both tests.
This automatically leads to diagnoses that come late. How important is early intervention in CKD?
Seewald: We also did a study on this. It was able to show that early treatment with so-called SGLT-2 inhibitors can spare patients from dialysis for a long time. This can succeed in delaying the time until blood purification by up to 13 years.
13 years?
Seewald: Yes. Dialysis severely restricts people; quality of life suffers. These can be 13 years in the prime of life. In addition, this is the most expensive phase of the disease.
Can you quantify that?
Seewald: There are also facts about this: The costs of treatment with dialysis increase 17-fold compared to treatment in the middle stage of CKD. Healthcare costs are already around 9 billion euros per year today; according to the prognosis of the InsideCKD study, they will be 10 billion euros per year in 2027. Of this, dialysis alone accounts for more than half of the costs – and this, although only around 5 percent of patients require dialysis.
So, to summarize: With 2 simple tests, millions of people can be protected from serious health complications and the system can save billions of euros?
Seewald: Absolutely correct. And this is truly not rocket science. We would just need to integrate 2 simple tests into everyday care and initiate drug therapy after diagnosis.
How can that work?
Seewald: In the short and medium term, we advocate for the inclusion of UACR screening in the disease management programs for risk groups such as chronic heart failure, coronary heart disease, diabetes mellitus, and obesity, as well as the entire CKD screening, i.e., eGFR and UACR, in the planned Check-up 50. In the long term, in our opinion, we need a disease management program for chronic kidney disease. Something like this already exists for diabetes; 60 percent of patients are reached in the DMP Diabetes. These are structured programs that ensure at all levels that people are treated according to the current state of research. As a basis for a DMP CKD, there would also need to be a National Care Guideline, which does not currently exist for CKD.
If the tests show that CKD is present: What can I do as a doctor then?
Seewald: Now we come to the SGLT-2 inhibitors, a class of active substances originally developed as antidiabetics and also used here. The medications are highly effective and safe. In the meantime, studies have shown that they also have cardioprotective effects, meaning they protect the heart and kidneys. It cannot be said often enough: early screening, timely diagnosis, and then therapy with an SGLT-2 inhibitor save people a lot of suffering and the system a lot of money. The treatment costs with an SGLT-2 inhibitor are well under 2 euros per day.
In his recommendations for a sustainably financed healthcare system, the Federal Minister of Health announced a legislative project on cardiovascular diseases – the number 1 cause of death in Germany. Wouldn't it be an idea to link chronic kidney disease to this?
Seewald: That would certainly make sense. Chronic kidney disease rarely occurs alone – it can develop, for example, from type 2 diabetes, high blood pressure, or other cardiovascular diseases. That's why it should be approached strategically. The question is: Which indications cause a particularly high disease burden in Germany, are expensive to treat or not to treat because we are lagging behind medical possibilities? In my view, the kidneys are definitely among them – also against the background that several new therapies are being tested in the pipelines of research companies, meaning that treatment can improve in the future. So why not a "Decade of the Kidney"? It urgently needs health policy support. Because we are getting older, the number of diseases is increasing, and with it the costs. Only in this way can we effectively treat one of the most expensive chronic diseases.
Further links:
AstraZeneca: Chronic Kidney Disease (CKD)
The interview was conducted by pharma-fakten.de
