A brand new study has found that recommendations and therapies for the diagnosis, prevention, and treatment of chronic kidney disease (CKD) were woefully underutilized in a number one American medical center.

Chronic kidney disease is a serious complication of diabetes that has significant effects on patients’ health and quality of life. While early stages of kidney disease don’t cause any symptoms, because the condition progresses it might probably turn out to be an immense medical, financial, and emotional burden. When weight loss plan and blood sugar control are usually not enough to stop kidney damage, patients may require dialysis and, eventually, a kidney transplant.

About half of the world’s individuals with type 2 diabetes will develop kidney disease, and about half of them will die from kidney failure or cardiovascular events attributed to kidney disease, in keeping with a 2022 study.

Is CKD identified quickly enough and treated properly? Do American patients get what they need to stop the event and progression of diabetic kidney disease? A gaggle of experts with the Cleveland Clinic, a number one nonprofit academic medical center, conducted a retrospective study of real-world treatments to seek out out.

The study, published within the Journal of Diabetes and its Complications, found a serious gap between clinical guidelines and actual practice, indicating that few patients were getting the eye that the medical system could offer:

• Only a few patients had their urine protein assessed as advisable.
• A minority of eligible patients were prescription drugs that may protect the kidneys.
• Visits with specialists reminiscent of nephrologists and endocrinologists were rare.

It could appear that Americans with diabetes are usually not getting the support they need to judge, prevent, or treat chronic kidney disease.

Diabetes Each day talked with Kevin Pantalone, DO, an endocrinologist and considered one of the study’s authors. Dr. Pantalone explained the character of this CKD treatment shortfall, and what to do about it.

DD: Only about 20 percent of individuals with type 2 diabetes received a urine protein assessment throughout the 12 months that your team examined, which the study calls “dismal.” How often should these tests be performed?

Dr. Pantalone: Ideally, all patients with type 2 diabetes should undergo assessment of urine protein on an annual basis.

Studies have shown that many patients with T2D have had the condition for nearly five years prior to the formal diagnosis being made by their healthcare provider. Thus, some patients may have already got evidence of CKD at or near the time of diagnosis.

Patients with proteinuria must be treated more aggressively. If one doesn’t check the urine protein in these patients, one doesn’t know who’s at the next risk of progressing to more severe types of CKD. Screening is very important, as often patients with proteinuria are asymptomatic. Screening allows for the identification for those at higher risk of CKD progression, allowing healthcare providers to implement more aggressive medical therapy to assist reduce that risk of progression.

DD: We were very surprised to see that only about 70 percent of those with T2D and CKD were using any type of glucose-lowering medicine. Should that number be higher?

Dr. Pantalone: Ideally, most patients needs to be receiving a glucose-lowering medication, although some patients who’ve T2D might be managed through lifestyle modification alone and should not necessarily require glucose-lowering therapy to manage their blood sugar.

Given the progressive nature of T2D, most patients will ultimately require pharmacological therapy to manage their blood sugar, with many patients requiring multiple therapies that work via different mechanisms to manage their blood sugar.

DD: Only about 8 percent of those with T2 and CKD saw a nephrologist, and 9 percent saw an endocrinologist. Should those numbers be higher?

Dr. Pantalone: There are usually not enough nephrologists or endocrinologists to administer the ever-expanding populations of patients with CKD, T2D, or each.

Generally, patients are referred to specialists later in the middle of disease. By that point, in lots of instances, the damage has already occurred. While milder cases of CKD and T2D can often be effectively managed by primary care providers, patients with more advanced disease must be identified through screening and referred to specialists for further evaluation and management.

DD: Are among the more necessary medications too expensive for many patients?

Dr. Pantalone: While we’ve actually seen some improvement over the past few years when it comes to the utilization of SGLT-2 inhibitors in patients with CKD, each with and without T2D, they continue to be grossly underutilized.

It is necessary to spotlight that the underutilization of therapies which have been shown to scale back the chance of CKD progression isn’t simply a problem related to the price of medication, as even ACE inhibitors (ACE-i) or angiotensin II receptor blockers (ARBs), each of that are low cost and have been demonstrated to scale back the chance of CKD progression, are underutilized. There continues to be an amazing opportunity for improvement when it comes to ensuring our patients are receiving the suitable therapies.

DD: The Cleveland Clinic is nationally renowned — are these results generalizable for the remainder of the country? Are you able to speculate if other health systems would have higher or worse results?

Dr. Pantalone: This isn’t a problem that is exclusive to Cleveland Clinic. There’s an inclination for patients with chronic medical conditions to experience therapeutic inertia, i.e., the failure to advance (or sometimes de-intensify) medical therapy when appropriate to accomplish that. This happens not only at large academic health centers, but additionally in small community-based medical practices. Patients have gotten ever more complex and have many comorbidities that require management.

DD: Why is diagnosing and treating CKD early so necessary?

Dr. Pantalone: Treating patients with type 2 diabetes (T2D) early and aggressively, to lower A1C, has been shown to scale back the chance of developing CKD, and to scale back the chance of progression of existing CKD.

Once a patient develops CKD, there isn’t a “turning back the clock.” You can’t undo the complications of T2D once they develop, it’s all about prevention. Once patients do develop CKD … the main target should be on identifying those at a high risk of progression. We must not only control the patient’s blood pressure and blood sugar, but additionally initiate therapies which have been demonstrated to slow the progression of CKD.