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Are there disparities in the early detection/clinical management of chronic kidney disease? (Content from AstraZeneca)

In this episode, we discuss kidney health inequalities with Professor David Wheeler, an Honorary Consultant Nephrologist and Professor of Kidney Medicine based at the Royal Free.

In this episode, we discuss kidney health inequalities with Professor David Wheeler, an Honorary Consultant Nephrologist and Professor of Kidney Medicine based at the Royal Free.

Professor David Wheeler would like his take-home messages to be:

  1. We think there are thousands of people in the UK who have chronic kidney disease; however, they do not know they’ve got it. Many of these individuals are in socioeconomically deprived groups. We need to pick up these patients because we now have effective treatments to slow progression of kidney disease.
  2. Think chronic kidney disease in the high-risk patient populations, e.g., patients with diabetes or patients with hypertension, then test these patients with a blood and urine test.
  3. Understand that nephrologists want to intervene as early as possible in kidney disease patients to prevent decline in kidney health, so if in doubt, refer to a nephrologist. Many nephrologists can offer virtual consultations or advise without needing to see the patient.

 

Useful links

 

References

  1. Kidney Research UK. Kidney Health Inequalities in the UK. 2019. Available at: https://kidneyresearchuk.org/wp-content/uploads/2019/09/Health_Inequalities_lay_report_FINAL_WEB_20190311.pdf (last accessed May 2021)
  2. Guthrie GD, Bell S. Deprivation and kidney disease-a predictor of poor outcomes. Clin Kidney J. 2019;13(2):128-132. doi: 10.1093/ckj/sfz151.
  3. Chronic kidney disease in England: the human and financial cost. Available at: https://www.england.nhs.uk/improvement-hub/wp-content/uploads/sites/44/2017/11/Chronic-Kidney-Disease-in-England-The-Human-and-Financial-Cost.pdf (last accessed May 2021)
  4. National Chronic Kidney Disease Audit // National Report: Part 2 December 2017. Available at: https://www.lshtm.ac.uk/media/9951 (last accessed May 2021)
  5. Hounkpatin HO, et al. Ethnic minority disparities in progression and mortality of pre-dialysis chronic kidney disease: a systematic scoping review. BMC Nephrol. 2020;21(1):217. doi: 10.1186/s12882-020-01852-3.
  6. NICE. Surveillance report 2017 – Chronic kidney disease. CG157, CG182 and NG8. Available at: https://www.nice.org.uk/guidance/cg182/resources/surveillance-report-2017-chronic-kidney-disease-stage-4-or-5-management-of-hyperphosphataemia-2013-nice-guideline-cg157-chronic-kidney-disease-in-adults-assessment-and-management-2014-nice-guideline–pdf-5740305984709 (last accessed May 2021)
  7. Kidney Disease: Improving Global Outcomes (KDIGO) CKD Work Group. KDIGO 2012 clinical practice guideline for the evaluation and management of chronic kidney disease. Kidney Int Suppl 2013;3:1-150.
  8. Iimori S, et al. Prognosis of chronic kidney disease with normal-range proteinuria: The CKD-ROUTE study. PLoS One. 2018;13(1):e0190493. doi: 10.1371/journal.pone.0190493.
  9. Fox CS, et al. Associations of kidney disease measures with mortality and end-stage renal disease in individuals with and without diabetes: a meta-analysis. Lancet. 2012;380(9854):1662-73. doi: 10.1016/S0140-6736(12)61350-6.
  10. Matsushita K, et al. Estimated glomerular filtration rate and albuminuria for prediction of cardiovascular outcomes: a collaborative meta-analysis of individual participant data. Lancet Diabetes Endocrinol. 2015;3(7):514-25. doi: 10.1016/S2213-8587(15)00040-6.
  11. NICE. Chronic kidney disease in adults: assessment and management. CG182. Available at: https://www.nice.org.uk/guidance/cg182 (last accessed May 2021)
  12. Kidney Disease: Improving Global Outcomes (KDIGO) Blood Pressure Work Group. KDIGO clinical practice guideline for the management of blood pressure in chronic kidney disease. Kidney Int Suppl 2012;2:337-414.
  13. Shlipak MG, et al. The case for early identification and intervention of chronic kidney disease: conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference. Kidney Int. 2021 Jan;99(1):34-47. doi: 10.1016/j.kint.2020.10.012.
  14. Gansevoort RT, de Jong PE. The case for using albuminuria in staging chronic kidney disease. J Am Soc Nephrol. 2009;20(3):465-8. doi: 10.1681/ASN.2008111212.
  15. Hirst JA, et al. Prevalence of chronic kidney disease in the community using data from OxRen: a UK population-based cohort study. Br J Gen Pract. 2020;70(693):e285-e293. doi: 10.3399/bjgp20X708245.
  16. Cravedi P, Remuzzi G. Pathophysiology of proteinuria and its value as an outcome measure in chronic kidney disease. Br J Clin Pharmacol. 2013; 76(4):516-23. doi: 10.1111/bcp.12104.
  17. Mallappallil M, et al. Chronic kidney disease in the elderly: evaluation and management. Clin Pract (Lond). 2014;11(5):525-535. doi: 10.2217/cpr.14.46.

In this episode, we discuss kidney health inequalities with Professor David Wheeler, an Honorary Consultant Nephrologist and Professor of Kidney Medicine based at the Royal Free.

Professor David Wheeler would like his take-home messages to be:

  1. We think there are thousands of people in the UK who have chronic kidney disease; however, they do not know they’ve got it. Many of these individuals are in socioeconomically deprived groups. We need to pick up these patients because we now have effective treatments to slow progression of kidney disease.
  2. Think chronic kidney disease in the high-risk patient populations, e.g., patients with diabetes or patients with hypertension, then test these patients with a blood and urine test.
  3. Understand that nephrologists want to intervene as early as possible in kidney disease patients to prevent decline in kidney health, so if in doubt, refer to a nephrologist. Many nephrologists can offer virtual consultations or advise without needing to see the patient.

 

Useful links

 

References

  1. Kidney Research UK. Kidney Health Inequalities in the UK. 2019. Available at: https://kidneyresearchuk.org/wp-content/uploads/2019/09/Health_Inequalities_lay_report_FINAL_WEB_20190311.pdf (last accessed May 2021)
  2. Guthrie GD, Bell S. Deprivation and kidney disease-a predictor of poor outcomes. Clin Kidney J. 2019;13(2):128-132. doi: 10.1093/ckj/sfz151.
  3. Chronic kidney disease in England: the human and financial cost. Available at: https://www.england.nhs.uk/improvement-hub/wp-content/uploads/sites/44/2017/11/Chronic-Kidney-Disease-in-England-The-Human-and-Financial-Cost.pdf (last accessed May 2021)
  4. National Chronic Kidney Disease Audit // National Report: Part 2 December 2017. Available at: https://www.lshtm.ac.uk/media/9951 (last accessed May 2021)
  5. Hounkpatin HO, et al. Ethnic minority disparities in progression and mortality of pre-dialysis chronic kidney disease: a systematic scoping review. BMC Nephrol. 2020;21(1):217. doi: 10.1186/s12882-020-01852-3.
  6. NICE. Surveillance report 2017 – Chronic kidney disease. CG157, CG182 and NG8. Available at: https://www.nice.org.uk/guidance/cg182/resources/surveillance-report-2017-chronic-kidney-disease-stage-4-or-5-management-of-hyperphosphataemia-2013-nice-guideline-cg157-chronic-kidney-disease-in-adults-assessment-and-management-2014-nice-guideline–pdf-5740305984709 (last accessed May 2021)
  7. Kidney Disease: Improving Global Outcomes (KDIGO) CKD Work Group. KDIGO 2012 clinical practice guideline for the evaluation and management of chronic kidney disease. Kidney Int Suppl 2013;3:1-150.
  8. Iimori S, et al. Prognosis of chronic kidney disease with normal-range proteinuria: The CKD-ROUTE study. PLoS One. 2018;13(1):e0190493. doi: 10.1371/journal.pone.0190493.
  9. Fox CS, et al. Associations of kidney disease measures with mortality and end-stage renal disease in individuals with and without diabetes: a meta-analysis. Lancet. 2012;380(9854):1662-73. doi: 10.1016/S0140-6736(12)61350-6.
  10. Matsushita K, et al. Estimated glomerular filtration rate and albuminuria for prediction of cardiovascular outcomes: a collaborative meta-analysis of individual participant data. Lancet Diabetes Endocrinol. 2015;3(7):514-25. doi: 10.1016/S2213-8587(15)00040-6.
  11. NICE. Chronic kidney disease in adults: assessment and management. CG182. Available at: https://www.nice.org.uk/guidance/cg182 (last accessed May 2021)
  12. Kidney Disease: Improving Global Outcomes (KDIGO) Blood Pressure Work Group. KDIGO clinical practice guideline for the management of blood pressure in chronic kidney disease. Kidney Int Suppl 2012;2:337-414.
  13. Shlipak MG, et al. The case for early identification and intervention of chronic kidney disease: conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference. Kidney Int. 2021 Jan;99(1):34-47. doi: 10.1016/j.kint.2020.10.012.
  14. Gansevoort RT, de Jong PE. The case for using albuminuria in staging chronic kidney disease. J Am Soc Nephrol. 2009;20(3):465-8. doi: 10.1681/ASN.2008111212.
  15. Hirst JA, et al. Prevalence of chronic kidney disease in the community using data from OxRen: a UK population-based cohort study. Br J Gen Pract. 2020;70(693):e285-e293. doi: 10.3399/bjgp20X708245.
  16. Cravedi P, Remuzzi G. Pathophysiology of proteinuria and its value as an outcome measure in chronic kidney disease. Br J Clin Pharmacol. 2013; 76(4):516-23. doi: 10.1111/bcp.12104.
  17. Mallappallil M, et al. Chronic kidney disease in the elderly: evaluation and management. Clin Pract (Lond). 2014;11(5):525-535. doi: 10.2217/cpr.14.46.

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GB-28291 | DOP May 2021

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