The case for early identification and intervention of chronic kidney disease: conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference

Conference Participants

Research output: Contribution to journalArticlepeer-review

Abstract

Chronic kidney disease (CKD) causes substantial global morbidity and increases cardiovascular and all-cause mortality. Unlike other chronic diseases with established strategies for screening, there has been no consensus on whether health systems and governments should prioritize early identification and intervention for CKD. Guidelines on evaluating and managing early CKD are available but have not been universally adopted in the absence of incentives or quality measures for prioritizing CKD care. The burden of CKD falls disproportionately upon persons with lower socioeconomic status, who have a higher prevalence of CKD, limited access to treatment, and poorer outcomes. Therefore, identifying and treating CKD at the earliest stages is an equity imperative. In 2019, Kidney Disease: Improving Global Outcomes (KDIGO) held a controversies conference entitled “Early Identification and Intervention in CKD.” Participants identified strategies for screening, risk stratification, and treatment for early CKD and the key health system and economic factors for implementing these processes. A consensus emerged that CKD screening coupled with risk stratification and treatment should be implemented immediately for high-risk persons and that this should ideally occur in primary or community care settings with tailoring to the local context.

Original languageEnglish (US)
Pages (from-to)34-47
Number of pages14
JournalKidney international
Volume99
Issue number1
DOIs
StatePublished - Jan 2021

Bibliographical note

Funding Information:
This conference was sponsored by KDIGO and supported in part by unrestricted educational grants from Akebia Therapeutics, AstraZeneca, Bayer HealthCare, Boehringer Ingelheim, Cricket Health, CVS Kidney Care, Fresenius Medical Care, Gentian, Janssen, Kyowa Kirin, Mundipharma, Reata, Relypsa, and Tricida. We thank Jennifer King, PhD, for assistance with manuscript preparation and Dr. Jennifer Lees for providing data from the UK Biobank Study. KDIGO also thanks the International Society of Nephrology (Dr. Aminu Bello and Sandrine Damster) and the International Society of Nephrology regional experts in the field for their participation in the CKD testing costs survey.

Funding Information:
This conference was sponsored by KDIGO and supported in part by unrestricted educational grants from Akebia Therapeutics, AstraZeneca, Bayer HealthCare, Boehringer Ingelheim, Cricket Health, CVS Kidney Care, Fresenius Medical Care, Gentian, Janssen, Kyowa Kirin, Mundipharma, Reata, Relypsa, and Tricida. We thank Jennifer King, PhD, for assistance with manuscript preparation and Dr. Jennifer Lees for providing data from the UK Biobank Study. KDIGO also thanks the International Society of Nephrology (Dr. Aminu Bello and Sandrine Damster) and the International Society of Nephrology regional experts in the field for their participation in the CKD testing costs survey.

Funding Information:
MGS declared having consultancy fees from Intercept Pharmaceuticals and University of Washington; stock equity from Cricket Health and TAI Diagnostics; research support from Booz Allen Hamilton; and future research support from Bayer U.S. SLT declared having consultancy fees from Bayer AG and research support from the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). MEG declared having research support from the National Kidney Foundation/National Institutes of Health (NIH). JHI declared having consultancy fees from AstraZeneca; future consultancy fees from Ardelyx; research support from NIDDK; and serving as Data and Safety Monitoring Board (DSMB) member for Sanifit. VJ declared having consultancy fees from AstraZeneca and Baxter Healthcare; and research support from Baxter Healthcare and GSK. A-PK declared having research support from European and Developing Countries Clinical Trials Partnership and future research support from the NIH. MM declared having consultancy fees from AstraZeneca and Bayer; future consultancy fees from AstraZeneca and Bayer; and research support from Fundación Gonzalo Río Arronte. NT declared having consultancy fees from AstraZeneca, Boehringer Ingelheim-Lilly, Janssen, and Otsuka; stock equity from Mesentech, Pulsedata, Rénibus, and Tricida; and research support from AstraZeneca, Janssen, Otsuka, and Tricida. MJ declared having consultancy fees from Amgen, AstraZeneca, Boehringer Ingelheim, Mundipharma, Merck Sharp & Dohme (MSD), and Vifor Fresenius Medical Care Renal Pharma; future consultancy fees from Astellas; speakers bureaus from Amgen, AstraZeneca, Menarini, Mundipharma, and MSD; research support from Amgen, MSD, and Otsuka; and future research support from AstraZeneca. WCW declared having consultancy fees from Akebia, AstraZeneca, Bayer, Janssen, Merck, Relypsa, and Vifor Fresenius Medical Care Renal Pharma; and research support from the NIH. All the other authors declared no competing interests.

Publisher Copyright:
© 2020 Kidney Disease: Improving Global Outcomes (KDIGO)

Keywords

  • albuminuria
  • chronic kidney disease
  • cost-effectiveness
  • creatinine
  • cystatin
  • detection
  • glomerular filtration rate
  • health systems
  • interventions
  • kidney failure
  • proteinuria
  • risk models
  • risk stratification
  • screening

PubMed: MeSH publication types

  • Practice Guideline
  • Research Support, Non-U.S. Gov't

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