ORGAN DAMAGE

CKD PROGRESSION DAMAGES MORE THAN THE KIDNEYS

Addressing CKD early may protect your patients’ kidneys—and heart

Patients with T2D and CKD were 3 times more likely to die of CV-related causes than patients with T2D alone1*

More than 60% of CKD patients have CVD2^,3

*A survey examining the all-cause mortality of patients with CKD and/or T2D in the US (N=15,046).

CKD: chronic kidney disease; CV: cardiovascular; CVD: CV disease; T2D: type 2 diabetes.

CKD in T2D may be centered in the kidneys, but kidney health has far-reaching implications for the rest of the body as well—especially CV events. As evidenced by the high rate of CV mortality in patients with CKD and T2D, the cardiovascular and renal systems have a close relationship. As the 3 drivers of CKD progression contribute to further kidney damage, the risk of a CV event also increases.^4,5

CKD has important kidney and CV implications5^-7

Kidney changes5^,6

Glomerular hypertrophy
Renal vascular damage
Kidney injury
Reduced blood flow

CV changes5^,6

Left ventricular hypertrophy
Arrhythmia
Cardiomyopathy
Reduced blood flow

CV-related mortality is a major risk for patients WITH CKD AND T2D1,2

Patients with CKD are 6 times more likely to die from a CV cause than develop ESKD. That risk increases as CKD progresses and the kidneys become further impaired. That’s why early detection of CKD in T2D is the first step towards slowing down CKD progression and preventing harmful CV outcomes.4^,8^,9

EARLY, REGULAR TESTING CAN HELP IDENTIFY CKD PROGRESSION4

For CKD in T2D, there are 2 main tests that are used to determine how well the kidneys are functioning:

Estimated glomerular filtration rate (eGFR)4

Measures how much creatinine (a waste product from kidney filtration) is in the blood
Is a more reliable indicator of later-stage kidney damage10
Reveals worsening kidney function when eGFR levels decline
A patient is typically diagnosed with CKD when their eGFR falls below 60 mL/min/1.73m2

Urine albumin-to-creatinine ratio (UACR)10,11

Measures how much albumin (a waste protein) is in the urine and puts it in a ratio to the level of creatinine
Is a more sensitive measure of kidney damage, especially earlier-stage kidney damage
Reveals if increased levels of albumin are in the urine
- High albuminuria (30-300 mg/g)12
- Very high albuminuria (>300 mg/g)12
Unlike eGFR, UACR demonstrates a linear relationship with CV mortality and can be used to estimate CV health

Patients with high albuminuria are 1.5 times more likely to die from CV events compared to patients with normal levels of albumin

These events include myocardial infarction, heart failure, sudden cardiac death, or stroke—and this risk is independent of eGFR.11

The damage to the kidney caused by CKD in T2D can occur at a cellular level, affecting the CV system before eGFR tests uncover an issue with kidney function. While both of these tests are recommended annually by KDIGO guidelines, the rates for screening for albuminuria are suboptimal worldwide.10^,13^,14

The chart below shows how the 2 tests, when used together, can determine the risk of progression to ESKD. It can be used when you suspect kidney damage and CV risk are increasing in patients with CKD and T2D.4

When leveraged together, increasing levels of albuminuria and reduced rates of eGFR indicate clinical manifestations of kidney damage4^,15

UACR and eGFR can show risk of progression

Blue: low risk of CKD progression; yellow: mild risk of CKD progression, with eGFR and UACR measurements suggested once per year; orange: moderate risk of CKD progression, with eGFR and UACR measurements recommended twice a year; red: high risk of damage, with eGFR and UACR measurements recommended 3 times a year; deep red: very high risk of CKD progression, with eGFR and UACR measurements recommended 4+ times per year. Based on recommended guidelines.

Protecting patients from kidney damage starts with the early detection of CKD4^,16

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References:

Afkarian M, et al. J Am Soc Nephrol. 2013;24(2):302–308. Return to content
Schefold JC, et al. Nat Rev Nephrol. 2016;12(10):610–623. Return to content
United States Renal Data System. https://usrds.org/2009/V1_FULL_09.zip. Bethesda, MD; 2018. Return to content
Kidney Disease Improved Global Outcomes Committee. Kidney Int. 2013;3(1):1–150. Return to content
Alicic RZ, et al. Clin J Am Soc Nephrol. 2017;12(12): 2032–2045. Return to content
Bauersachs J, et al. Hypertension. 2015;65(2):257–63. Return to content
Thomas MC, et al. Nat Rev Dis Primers. 2015;1:15018. Return to content
Dalrymple LS, et al. J Gen Intern Med. 26(4):379–385. Return to content
Fox CS, et al. Lancet. 2012;380(9854):1662–1673. Return to content
Campion CG, et al. Can J Kidney Health Dis. 2017;4:2054358117705371. Return to content
Van der Velde M, et al. Kidney Int. 2011;79(12):1341–1352. Return to content
Sacks DB, et al. Diabetes Care. 2011;34:e61-e99. Return to content
Willison A, et al. BMJ Qual Improv Rep. 2016;5(1). Return to content
Kidney Disease Improved Global Outcomes Committee. KDIGO 2012. Kidney Int. 2013;3(1):1–150. Return to content
Levey AS, et al. Kidney. 2011;80(1):17–28. Return to content
Sprangers B, et al. Mayo Clin Proc. 2006;81(11):1487–1494. Return to content