Low Adherence to Kidney Disease: Improving Global Outcomes 2012 CKD Clinical Practice Guidelines Despite Clear Evidence of Utility

Glen James; Juan Jose Garcia Sanchez; Juan Jesus Carrero; Supriya Kumar; Roberto Pecoits-Filho; Hiddo J L Heerspink; Stephen Nolan; Carolyn S P Lam; Hungta Chen; Eiichiro Kanda; Naoki Kashihara; Matthew Arnold; Mikhail N Kosiborod; Mitja Lainscak; Carol Pollock; David C Wheeler

doi:10.1016/j.ekir.2022.05.033

Low Adherence to Kidney Disease: Improving Global Outcomes 2012 CKD Clinical Practice Guidelines Despite Clear Evidence of Utility

Kidney Int Rep. 2022 Jun 8;7(9):2059-2070. doi: 10.1016/j.ekir.2022.05.033. eCollection 2022 Sep.

Authors

Glen James¹, Juan Jose Garcia Sanchez², Juan Jesus Carrero³, Supriya Kumar⁴, Roberto Pecoits-Filho^{5

6}, Hiddo J L Heerspink⁷, Stephen Nolan¹, Carolyn S P Lam^{8

9}, Hungta Chen¹⁰, Eiichiro Kanda¹¹, Naoki Kashihara¹¹, Matthew Arnold¹², Mikhail N Kosiborod¹³, Mitja Lainscak^{14

15}, Carol Pollock¹⁶, David C Wheeler¹⁷

Affiliations

¹ Global Medical Affairs, BioPharmaceuticals Medical, AstraZeneca, Cambridge, UK.
² Global Market Access and Pricing, BioPharmaceuticals Medical, AstraZeneca, Cambridge, UK.
³ Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
⁴ Real World Data Science, BioPharmaceuticals Medical, AstraZeneca, Gaithersburg, Maryland, USA.
⁵ School of Medicine, Pontifical Catholic University of Parana, Curitiba, Brazil.
⁶ Arbor Research Collaborative for Health, Ann Arbor, Michigan, USA.
⁷ Department of Clinical Pharmacy and Pharmacology, University of Groningen, Groningen, Netherlands.
⁸ Department of Cardiology, National Heart Center, Singapore.
⁹ Duke-NUS Medical School, Singapore.
¹⁰ Medical and Payer Evidence Statistics, BioPharmaceuticals Medical, AstraZeneca, Gaithersburg, Maryland, USA.
¹¹ Kawasaki Medical School, Kurashiki, Japan.
¹² Real World Data Science, BioPharmaceuticals Medical, AstraZeneca, Cambridge, UK.
¹³ Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City, Kansas City, Missouri, USA.
¹⁴ Division of Cardiology, General Hospital Murska Sobota, Murska Sobota, Slovenia.
¹⁵ Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia.
¹⁶ Kolling Institute, Royal North Shore Hospital, University of Sydney, Sydney, New South Wales, Australia.
¹⁷ Department of Renal Medicine, University College London, London, UK.

Abstract

Introduction: Kidney Disease: Improving Global Outcomes (KDIGO) 2012 guidelines classify chronic kidney disease (CKD) risk or prognosis using estimated glomerular filtration rate (eGFR) and urinary albumin-to-creatinine ratio (UACR). We assessed patient characteristics and outcomes according to the KDIGO classification, using data from DISCOVER CKD (NCT04034992).

Methods: Data were extracted from the US integrated Limited Claims and Electronic Health Record Dataset and TriNetX databases, and the UK Clinical Practice Research Datalink linked to Hospital Episode Statistics and Office for National Statistics databases. Eligible patients were aged ≥18 years with CKD, and identified by 2 consecutive eGFR measures (5 to <75 ml/min/1.73 m²; ≥90 days apart [maximum 730]) from January 2008. Index date was the second eGFR measurement; patients were categorized using the UACR measure closest to the index. Outcomes included patient characteristics, eGFR or UACR measurement frequency, and clinical outcomes per baseline KDIGO classification.

Results: Across databases, only 8.6% of patients with 2 eGFR measures had ≥1 UACR measures. Among 123,807 eligible patients, prevalence of heart failure, hypertension, and type 2 diabetes increased with increasing albuminuria. Incidence rates of mortality and adverse cardiovascular and renal outcomes increased with declining baseline eGFR, and particularly with increasing albuminuria. Median number of eGFR and UACR tests per year post-index ranged from 1.6 to 2.5 and 0.5 to 0.6, respectively, across databases; there was no clear increase in UACR testing frequency following the KDIGO 2012 guidelines.

Conclusion: Albuminuria monitoring is critical for optimal risk stratification in CKD, and our findings highlight an imperative for more regular UACR testing in clinical practice.

Keywords: DISCOVER CKD; Kidney Disease: Improving Global Outcomes; chronic kidney disease; estimated glomerular filtration rate; retrospective; urinary albumin-to-creatinine ratio.

Associated data

ClinicalTrials.gov/NCT04034992