New analysis of a mathematical model by AstraZeneca, IMPACT CKD, suggests that healthcare systems in Germany, the Netherlands, Spain and the United Kingdom can save €15.8 billion over 10 years by implementing early, targeted screening for chronic kidney disease (CKD). ) in patients with risk factors such as type 2 diabetes and hypertension and with early use of guideline-directed medical therapies1. And through earlier diagnosis and treatment, it is possible to reduce the risk of disease progression and, therefore, the probability and costs associated with the management of possible cardiovascular events1. Data from IMPACT CKD, the first study to examine and predict the major impact of CKD over a 10-year time horizon, have been presented at the 61st Congress of the European Renal Association (ERA) in Stockholm , along with additional data from ACT ON CKD (Accelerating Change Together), a CKD evidence programme, demonstrating the health and economic impact of the growing global burden of CKD1-5.
Model analysis in the four European countries cited projects that, in patients at high risk for CKD, screening and early use of guideline-directed treatment would result in approximately 774,800 fewer heart attacks, 554,400 fewer hospitalizations for heart failure events heart attack (HF) and 338,200 fewer strokes in 10 years, compared to current practice1. Likewise, the cost savings associated with the reduction of clinical events would amount to almost €15.8 billion over a 10-year period, the equivalent of the combined salaries of more than 297,000 hospital nurses in the four countries.1.6.
On the other hand, a second analysis of IMPACT CKD data in these European countries further highlights the importance of targeted screening and guideline-directed treatment for patients at high risk of CKD, providing potential clinical benefits for patients, as well as cost savings2. By implementing these strategies, the analysis predicted a reduction in the incidence of undiagnosed CKD (stage 1-2: 49.2% to 71.6%, stage 3-5: 60.2% to 69.8%) , dialysis (from 22.6% to 41.9%), cardiovascular events (from 44.6% to 49.1%) and mortality (from 4.5% to 9.1%) compared to current practice2.
Professor Steven Chadban, Professor of Renal Medicine at the University of Sydney, Australia and investigator of the IMPACT CKD study, said: “When left untreated, CKD can have a significant impact on a patient’s health beyond function. renal. Those living with the disease also have an increased risk of cardiovascular complications, such as myocardial infarction and heart failure, which share common risk factors such as diabetes and hypertension. “Proactive, routine screening in primary care settings can help identify and manage CKD at earlier stages, with the potential to improve patient outcomes and reduce costs associated with the management of cardiovascular events.” .
Real-world evidence data from the DISCOVER CKD3 study have also been presented at the European Renal Association Congress. This data from patients across the UK, US, Spain, Italy, Sweden and Japan shows that, in addition to screening, early treatment (Stage 3) of CKD plays a critical role in reducing the impact of CKD. on patients (patient-reported outcomes) and health systems3. A preliminary analysis shows that, over a 12-month follow-up period, patients taking renin-angiotensin system inhibitors and sodium-glucose cotransporter type 2 inhibitors had a 67% lower risk of all-cause mortality and a 20% lower risk of all-cause hospitalization compared to patients not receiving kidney-protective medication3.
Meanwhile, multinational survey data from the PaCE CKD trial demonstrate that the burden of CKD not only represents a high cost to economies, but can also reduce the quality of life of both patients and caregivers4. The results show that those living with CKD report 24% lower scores in surveys that evaluate general health status and health-related quality of life compared to the general population4 and, in addition to deteriorated health states, Patients also report high impairment in work and non-work activities, with higher rates of absenteeism and presenteeism4. In a second analysis of PaCE CKD data, caregivers reported similar challenges, including significantly impaired health states, adverse quality of life, financial problems, and reduced work productivity due to absenteeism and presenteeism5.
“The evidence presented at the ERA Congress demonstrates both the urgent need to improve CKD policies and the potential for such changes to lead us towards an brighter future for patients and their loved ones, as well as cost savings for healthcare systems. AstraZeneca remains dedicated to working with policymakers and health systems around the world to improve access to screening for at-risk patients and guideline-directed treatment for those living with CKD, so they can live a better life. fuller and healthier.”
The IMPACT CKD, PaCE CKD and DISCOVER CKD studies are part of AstraZeneca’s ACT on CKD initiative, which aims to improve the understanding and outcomes of CKD worldwide. Through the ACT on CKD programme, AstraZeneca, together with the Global Patient Alliance for Kidney Health (GloPAKH), has launched the ‘Make the Change for Kidney Health’ campaign. This initiative seeks to position CKD on the global political agenda, advocating for comprehensive and effective disease management strategies to combat this growing health challenge.
About chronic kidney disease (CKD)
Almost 850 million people worldwide suffer from CKD7although the majority are not diagnosed8. The most common causes of CKD are diabetes, hypertension and glomerulonephritis9. CKD is associated with significant patient morbidity and an increased risk of cardiovascular (CV) events, such as myocardial infarction and heart failure (HF), leading to premature death.10. In its most severe form, known as end-stage chronic kidney disease, kidney damage and deterioration in kidney function have progressed to the point where dialysis or kidney transplant is requiredeleven. The majority of patients with CKD will die before reaching the point of needing Renal Replacement Therapy 12.
ACT on CKD
ACT on CKD is a program to transform kidney health with the goal of reducing by 20% the percentage of patients who progress to end-stage CKD by 2025. To realize this ambition, the program supports initiatives aimed at increasing the raise awareness of the burden of CKD and its consequences, expand early detection and drive treatment optimization to improve patient outcomes. To continue supporting people at risk of CKD, we also seek to achieve sustainable change through health policy reforms.
We want to provide patients, healthcare professionals and decision makers with the information they need to drive change. As part of our broader contribution to CKD knowledge, we continue to generate evidence to help advance clinical practice: DISCOVER-CKD shows lack of evidence for urinary albumin-creatinine ratio and adherence to guidelines Kidney Disease Improving Global Outcomes (KDIGO); REVEAL-CKD shows the extent of the gaps in early detection of CKD and the clear benefits of early diagnosis; INSIDE-CKD shows the unsustainable burden future of CKD and the potential benefits to the healthcare system of better management; PACE-CKD shows that CKD is associated with a worse quality of life not only for patients but also for their caregivers; and IMPACT CKD provides models of the future burden of CKD for public health policy planning, including social and environmental impact.
References
1. Rao N, et al. Impact of CKD screening in high-risk populations and guideline-directed therapy on the occurrence of CV events and costs in Europe: an IMPACT CKD analysis. Presented at: ERA 2024, May 23-26, 2024, Stockholm, Sweden.
2. Rao N, et al. Impact of CKD screening in high-risk populations and guideline-directed therapy on RRT, CV events and mortality in Europe: an IMPACT CKD analysis. Presented at: ERA 2024, May 23-26, 2024, Stockholm, Sweden.
3. Pecoits Filho R, et al. Kidney protective medications and risk of adverse clinical outcomes in patients with chronic kidney disease: preliminary findings from DISCOVER CKD. Presented at: ERA 2024, May 23-26, 2024, Stockholm, Sweden.
4. PaCE CKD: Examination of Health Status and Financial Burden in Patients with Chronic Kidney Disease: Assessment of the Nonclinical Burden of Disease. Presented at: ERA 2024, May 23-26, 2024, Stockholm, Sweden.
5. PaCE CKD: The impact of caregiving on health states and work productivity in chronic kidney disease: results of an international survey. Presented at: ERA 2024, May 23-26, 2024, Stockholm, Sweden.
6. OECD. “Nurses’ pay”, in Health Outlook 2023: OECD Indicators. OECD. 2023. https://doi.org/10.1787/f8818f26-en.
7. Jager KJ, et al. A unique figure for promotion and communication: worldwide, more than 850 million people suffer from kidney diseases. Nephrol dial transplant. 2019;34(11):1803-1805.
8. Bikbov B, et al. Global, regional and national burden of chronic kidney disease, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet. 2020;395(10225):709-733.
9. National Kidney Foundation [Internet]. Chronic Kidney Disease (CKD); [consultado el 25 de marzo de 2024]. Available at: https://www.kidney.org/atoz/content/about-chronic-kidney-disease.
10. Centers for Disease Control and Prevention (CDC) [Internet]. Chronic kidney disease: common, serious and expensive; [consultado el 25 de marzo de 2024]. Available at: https://www.cdc.gov/kidneydisease/prevention-risk/CKD-common-serious-costly.html.
eleven. Centers for Disease Control and Prevention (CDC) [Internet]. Chronic kidney disease in the United States; 2021 [consultado el 25 de marzo de 2024]. Available at: https://www.cdc.gov/kidneydisease/pdf/Chronic-Kidney-Disease-in-the-US-2021-h.pdf.
12. Briasoulis A, et al. Chronic kidney disease as a risk equivalent for coronary artery disease. Curr Cardiol Rep. 2013;15(3):340.
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