CKD: This Silent Killer Deserves More Attention

Calling chronic kidney disease (CKD) the “silent killer” may at first sound dramatic. However, sadly, this metaphor is indeed apt. CKD is a devastating disease that often sneaks up on people, wreaking havoc on their lives, impacting their families and affecting their future.

Chronic kidney disease is particularly dangerous because the symptoms emerge slowly and silently and are often detected only when it has reached stage 3 or later, when damage is already severe and irreversible. Patients can lose 30% to 40% of kidney function without showing symptoms.¹

Human Hardship and Monetary Expense

The toll related to CKD in relation to both human hardship and treatment is overwhelming:

• Because kidney disease is often symptom-free until it has significantly diminished the ability of the organ to function, approximately 90% of people with kidney disease don’t know they have it
• Even more alarming: 2 out of 5 people with severe kidney disease don’t know they have it²
• Treatment can be time-consuming for some patients; according to the Centers for Disease Control and Prevention (CDC), in 2021, over 500,000 patients will receive kidney dialysis in the U.S.³
• The mortality rates associated with CKD are striking; after adjustment for age, gender, race, comorbidity and prior hospitalizations, mortality in patients with CKD in 2009 was 56% greater than that in patients without CKD⁴

And, along with pain and discomfort comes a significant monetary investment:

• In 2018, treating Medicare beneficiaries with CKD cost over $81.8 billion, and treating people with end stage renal disease (ESRD) cost an additional $36.6 billion⁵
• The estimated cost of care of stage 1-4 CKD per year can be 1.6-2.4 times more than renal replacement therapy
• One year of hemodialysis can cost up to $72,000, while a year of peritoneal dialysis costs about $53,000, according to information from a 2014 Modern Healthcare article⁶

Sadly, children are not immune to chronic kidney disease and its consequences. Morbidity and mortality among children with CKD and ESRD are much lower than among adults with these conditions, but they are strikingly higher than for healthy children. As with adults, the risk is highest among dialysis patients; consequently, transplantation is the preferred treatment for pediatric patients with ESRD.⁷

Improving Identification and Outcomes

If this disease is so prevalent, why isn’t it detected earlier? There are a few reasons, including a delay in testing. Although a simple test can detect protein in the urine, which is the first sign of trouble, these tests are not routinely ordered. When these tests are administered, protein in the urine frequently is not flagged as CKD, partly because patients without symptoms are not pressing for a diagnosis.⁸

Indeed, routine testing for kidney disease should be encouraged universally. All individuals should be assessed, as part of routine health encounters.⁹

The advantage of early diagnosis and treatment cannot be overstated. The benefits of early diagnosis of CKD for patients and for society are tremendous. Patients who are diagnosed in the early stages of kidney disease have the chance to make lifestyle changes, learn how to manage their disease and extend their lives while avoiding or postponing the need for dialysis or transplant. Society benefits because of the reduced cost of caring for patients with late-stage kidney disease.¹⁰

Raising the Bar for CKD Patients

With statistics on the insidious and often deadly nature of CKD now well-documented, I’m calling on all of us within the kidney disease community to work collectively to achieve better outcomes, including:

• Making research a standard offering to kidney patients
• Educating health care staff about the benefits of early diagnosis
• Moving forward with further research in this area
• Better promoting the signs and symptoms of CKD to the public
  • One of the ways Frenova is assisting with public education is the introduction of My Reason, a new research program intended to build a diverse health database. Participants help this research by consenting to share their genetic information (such as the sequence of their DNA) and the health information in their medical records.

References:

¹Fighting a Silent Killer: Identifying Chronic Kidney Disease at Stage 1, September 17, 2019, Mandeep Sahani, MD
²The National Kidney Foundation website, Newsroom, Fast Facts, Kidney.org
³COVID-19 Vaccine: What Public Health Jurisdictions and Dialysis Partners Need to Know, CDC.gov
⁴Chronic Kidney Disease (CKD), Updated: Apr 02, 2021, Author: Pradeep Arora, MD; Chief Editor: Vecihi Batuman, MD, FASN
⁵Chronic Kidney Disease Basics, CDC.gov
⁶Home dialysis grows despite cost and logistical hurdles, Steven Ross Johnson, 2014, ModernHealthcare.com
⁷Chronic Kidney Disease (CKD), Updated: Apr 02, 2021, Author: Pradeep Arora, MD; Chief Editor: Vecihi Batuman, MD, FASN
⁸Fighting a Silent Killer: Identifying Chronic Kidney Disease at Stage 1, 2019, Mandeep Sahani, MD, EndocrinologyAdvisor.com
⁹Clinical Practice Guidelines: For Chronic Kidney Disease: Evaluation, Classification and Stratification, 2002, Kidney.org
¹⁰Fighting a Silent Killer: Identifying Chronic Kidney Disease at Stage 1, Mandeep Sahani, MD, EndocrinologyAdvisor.com

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