Chronic Kidney Disease
Chronic kidney disease (CKD) is a term that encompasses all degrees of decreased kidney function, from mild or moderate disease to severe and end stage organ failure. Continued damage or trauma to the kidneys may occur as a result of other long-term diseases, such as diabetes or cardiovascular conditions. Such trauma to the tissue in the kidneys may lead to fibrosis, which if unchecked results in kidney failure, dialysis or organ transplantation.
In the United States, more than 1 in 7 adults (i.e., 15% of the adult population, or 37 million people) are estimated to have CKD. Nearly 786,000 people in the United States, or 2 in every 1,000 people, are currently living with end-stage renal disease (ESRD): 71% are on dialysis and 29% are living with a kidney transplant. Overall, kidney disease is the ninth leading cause of death in the United States.
In 2017, 697.5 million cases of CKD (all stages) were recorded worldwide, for a global prevalence of 9.1%. Globally, 1.2 million people died from CKD in 2017, where the global all-age mortality rate from CKD increased 41.5% from 1990 to 2017. Diabetic nephropathy accounted for almost a third of disability-adjusted life years (DALYs) from CKD.
Patients with CKD generally experience progressive loss of kidney function and are at risk for ESRD. The rate of progression depends on age, the underlying diagnosis, the implementation and success of secondary preventive measures, and the individual patient. Timely initiation of chronic renal replacement therapy is imperative to prevent the uremic complications of CKD that can lead to significant morbidity and death.
Unadjusted rates of hospitalisation in the CKD population, reflecting its total disease burden, are 3-5 times higher than those of patients without CKD. Rates of hospitalisation for cardiovascular disease and bacterial infection are particularly elevated in CKD patients.
The mortality rates associated with CKD are striking. After adjustment for age, gender, race, comorbidity, and prior hospitalisations, mortality in patients with CKD in 2009 was 56% greater than that in patients without CKD. For patients with stages 4-5 CKD, the adjusted mortality rate is 76% greater.
In the latter stages of ESRD, patients require dialysis and ultimately may be candidates for kidney transplantation. The prognosis is generally poor though, where the 5-year survival rate for a patient undergoing long-term dialysis in the United States is approximately 35%, and approximately 25% in patients with diabetes.
Early diagnosis and treatment of the underlying cause and/or the institution of secondary preventive measures are imperative in patients with CKD. These steps may delay, or possibly halt, progression of the disease. The primary pharmacologic measures taken for CKD include the use of sodium–glucose cotransporter 2 (SGLT2) inhibitors, angiotensin-converting enzyme inhibitors (ACEs) or angiotensin-receptor blockers (ARBs) in patients with proteinuria and use of nonsteroidal mineralocorticoid receptor (MR) antagonists.
There are currently no treatments available for kidney fibrosis, and which address the disease progression arising from the continued organ injury in CKD patients. Finding an effective treatment for CKD patients remains one of the global healthcare industry’s largest unmet needs.
- Vos T, Lancet 2020; 395: 709–33
- 2018 USRDS Annual Data Report | Volume 2: ESRD In The United States
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