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Identifying Patients Eligible for CKD Screening Process


The screening process for CKD is discussed by Susanne Nicholas, MD, MPH, PhD.

Ryan Haumschild, PharmD, MS, MBA: Speaking of early detection, I’ve realized that we all can agree that that’s a best practice. We’ve talked about who should be involved, but really, Dr Nicholas, you have a lot of involvement in CKD [chronic kidney disease], and you talked about early detection earlier on in our segment. And so if you could, how are patients screened for CKD? Is there anything else you want to add, and what is the role [of] estimated glomerular filtration rate, or eGFR, and the uACR [urine albumin-creatinine ratio] that was mentioned earlier? And should that be done for every patient? Is that something that should be more standard than it is already? And if you could, talk about what makes a patient eligible for screening—[whether] there are any specific comorbidities that you identify or things that you feel are important to call out.

Susanne B. Nicholas, MD, MPH, PhD: Well, thanks for that. I think I’m going to start with the last question in terms of what makes a patient eligible for chronic kidney disease screening, because chronic kidney disease screening is not routine. It’s not something that every physician does. And so it’s important to identify individuals who are at risk for chronic kidney disease…. And there are a number of risk factors. And we mentioned being aware, and this is where the awareness comes in because if you’re aware of what the risk factors are, then you’re more inclined to screen the patient for chronic kidney disease. And there are a number of risk factors. We’ve already mentioned one in terms of patients who belong to those vulnerable populations, but also aging individuals, individuals who are over age 65 [years and] certainly individuals who have a history of diabetes, history of hypertension, who have a family history of chronic kidney disease or kidney failure. Those individuals specifically need to be tested for chronic kidney disease. And how do we do that? So there are 2 labs that we typically order to diagnose chronic kidney disease. One is the eGFR…that you mentioned, and that eGFR is really a measure of kidney function. It’s derived from a blood test for serum creatinine, and that creatinine is a breakdown product of muscle…and gets excreted through the kidneys at a fairly constant rate. And so we can use that as a surrogate to identify kidney function because if your kidneys aren’t working well, you can’t excrete the creatinine that builds up in your blood. And as that creatinine measurement goes up, then we take that same creatinine [and] we put it into an equation to determine the eGFR, and that eGFR allows us to stage chronic kidney disease stages 1 through 5. So that’s important. But in addition to the eGFR, there’s also the urine albumin-creatinine ratio, and that…is a significant factor when it comes to looking at risk for cardiovascular disease. But it also helps as those 2 numbers, the eGFR and the uACR, help us to risk-stratify patients so that we can look at what’s called a KDIGO [Kidney Disease: Improving Global Outcomes] grid or heat map, where you’ve got eGFR and uACR at different categories. And that allows us to stage and to see how patients progress over time depending on the levels of those numbers. So it’s important to have those numbers but probably important to have it early on. So at the time of identification of chronic kidney disease, having both of those numbers puts the provider and the patient in a wonderful position to know where they stand in terms of their level of kidney function and risk for progression, so that the therapies that have been out there as standard of care may be implemented.

Ryan Haumschild, PharmD, MS, MBA:It’s a great overview, and I think highlighting which lab should be ordered is important…. And I agree with you. If you could maybe characterize just a little bit further a successful program. Many of us who are watching this are saying, “OK, maybe there’s a need for me to implement something within the payer arm of my organization or within the integrated delivery network or the health system or clinic.” And so what [does] success look like in a program? And lastly, how can they not just establish a program but really focus in on that early screening?

Susanne B. Nicholas, MD, MPH, PhD: So this is what we all aim for, is to have that perfect CKD program. The way that our system is designed these days, as you’ve heard, we’re very siloed. It’s not where we’ve got all the subspecialists in 1 place to…make that important contribution to the care for patients with chronic kidney disease. So the ideal environment would be one where we’ve got the multidisciplinary team all together, where [everyone] can have an input [on] that patient in terms of their diagnosis of CKD, their risk of progression, the medications that they need, and all of the ancillary things that are needed to make sure that that patient’s care is optimized. That would be ideal. I think we can shoot for [that]…and one way that we can do [this] is if we don’t have everyone in the same place…. It’s through telemedicine, for example, or e-consults where we can reach out to our cardiology colleagues, our endocrinology colleagues, to provide input to the patients. But in addition to having the subspecialists, we also need pharmacists, we also need nutritionists, we [also] need diabetes educators. There are a number of other ancillary care individuals who are needed when it comes to providing optimal care for patients with chronic kidney disease, primarily because there are so many additional complications that can occur in these patients.

Ryan Haumschild, PharmD, MS, MBA: I think multidisciplinary care is key to a program, but really in CKD, as you mentioned, there are so many comorbidities and there are so many key counseling points that when you bring the team together and everyone’s bringing their different expertise, ultimately the patient’s going to win. And if the patient wins, we get better controlled disease and hopefully we can help manage that benefit and reduce those costs of care that can be associated with it.

Transcript is AI-generated and edited for clarity and readability.

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