Early diagnosis saves lives: focus on patients with chronic kidney disease

Abstract

Chronic kidney disease is a global public health problem. Patients with chronic kidney disease have an increased risk of developing end-stage kidney disease and its complications. Early identification and management of patients with chronic kidney disease is important in order to decrease the morbidity and mortality. Early detection of chronic kidney disease is possible with screening programs targeting high-risk patients, such as patients with diabetes mellitus, hypertension, elderly patients, and patients having a family history of chronic kidney disease.

Chronic kidney disease is a common and important public health problem with a severe economic burden on the society. The presence of chronic kidney disease is associated with decreased quality of life and increased mortality.¹ The risk of morbidity and mortality increases as the patients with chronic kidney disease progress to end stage. The incidence and prevalence of end-stage kidney disease differ substantially across countries. More than 80% of the patients receiving renal replacement therapies are in developed countries. The lower figures reported from poor countries are largely because of patients not being able to have renal replacement therapies.²

There is a worldwide increase in the prevalence and incidence of patients with end-stage kidney disease. This is mainly because of the aging population and the growth in the prevalence of diabetes, hypertension, and obesity.³ Diabetes and hypertension are the leading causes of chronic kidney disease in all developed and many developing countries. Cardiovascular risk increases as the patients with chronic kidney disease progress to end-stage kidney disease. Cardiovascular disease is the most common cause of morbidity and mortality in these patients.⁴

Early detection of people at risk for kidney disease provides an opportunity to prevent or delay the progression of chronic kidney disease. It is well documented that control of blood pressure with drugs that inhibit the renin–angiotensin system is both renoprotective and cardioprotective. Moreover, lifestyle modifications, such as cessation of smoking, control of body weight, low-protein diet, restriction of salt, and optimal glycemic control in diabetic patients are important measures to be taken to prevent the progression of renal disease and to decrease the cardiovascular risk.^{5, 6} Avoidance of potential nephrotoxic agents, such as nonsteroidal anti-inflammatory drugs, is also important for the renoprotection of these patients.

Screening programs have been developed in many countries in order to detect patients with chronic kidney disease. Screening programs may also promote public awareness and education.⁷ Screening for chronic kidney disease can occur in many contexts, including during routine care, within high-risk populations, and in the general population. Individuals can be screened for chronic kidney disease by testing the urine for protein (micro- or macroalbuminuria) and testing the blood for serum creatinine to estimate glomerular filtration rate. There is a lack of evidence to support the cost effectiveness of screening the general population.⁸ The International Society of Nephrology recommends that patients diagnosed with diabetes and hypertension should have regular screening for development of kidney disease. It is also recommended that subjects older than 55 years of age and close relatives of patients with nephropathy caused by diabetes, hypertension, and glomerulonephritis should also be the primary targets for screening to detect clinically silent kidney disease. Traditional cardiovascular disease risk factors should be screened in all patients with chronic kidney disease.⁹

Despite its recognition as an important public health problem, awareness of chronic kidney disease remains low. Low awareness is common both among patients and health-care providers.¹⁰ Many patients' being asymptomatic during the course of their disease is an important factor for the delayed diagnosis. Incorrect or late diagnosis results in delayed referrals to nephrologists. Late referral of patients with chronic kidney disease to nephrologists leads to missed opportunities to implement strategies for slowing the progression of disease, cardiovascular protection, and preparation for renal replacement therapies. Thus, late referral is associated with a higher risk of morbidity and mortality.¹¹

Education of patients and physicians in order to increase awareness of chronic kidney disease is one of the important measures to be taken. There should be national policies for both public health and medical professionals to educate their societies on the importance of screening and early detection of kidney disease on prevention.⁹ This approach will also have a positive economic impact on cost of chronic kidney disease.

Publication costs for this article were supported by the Turkish Society of Hypertension and Renal Diseases, a nonprofit national organization in Turkey.