The Silent Killer Among Us: Chronic Kidney Disease

‍“The unseen enemy is always the most fearsome.”  - George R.R. Martin‍

Among the most serious healthcare conditions are those that stealthily impair vital organs, remaining asymptomatic until the disease progresses to late stages. Chronic kidney disease (CKD) exemplifies this pattern. Individuals diagnosed with this disease often have severe loss of kidney function before having symptoms, potentially leading to end-stage renal disease requiring dialysis or kidney transplant.  

In fact, among the estimated 15% of adults with chronic kidney disease, 90% of them are unaware that they have it.  

‍Identifying individuals at risk or in an early stage of a disease is most beneficial when there are interventions that can prevent or slow the progression of the condition. Fortunately, CKD can be prevented or slowed with lifestyle changes, including:

• Controlling high blood pressure
• Controlling blood sugar for those with diabetes
• Engaging in an active lifestyle
• Maintaining a healthy weight or losing weight for those who are overweight
• Smoking cessation for those who smoke
• Avoiding the use of certain drugs, including non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen 
• Restricting dietary protein, potassium, sodium, and phosphorus depending on disease stage and comorbidities‍

The High Cost of End-Stage Renal Disease (ESRD)

The costs of treating end-stage renal disease are exponentially higher than those related to earlier stages. Risk mitigation steps to prevent or slow the progression of CKD may reduce spending by decreasing the number of individuals who advance to end-stage disease.  

Individuals in later stages of CKD also have increased risks for conditions like cardiovascular disease, anemia, and osteoporosis, leading to additional morbidity and higher costs.   

Who is at Risk?

Diabetes and high blood pressure are the two most common risk factors for CKD, accounting for about 64% of individuals with the condition.

‍But there are many other risk factors, including family history, cardiovascular disease, obesity, smoking, older age, certain autoimmune diseases, and prolonged use of NSAIDs (e.g., ibuprofen).

While screening for CKD is performed using relatively inexpensive lab tests, the United States Preventive Services Task Force (USPSTF) concluded that there was insufficient evidence to recommend routine screening in asymptomatic adults after evaluating the benefits of early treatment in the general population vs. harms of screening. Several healthcare organizations, like the American Diabetes Association and the National Kidney Foundation, recommend targeted screening in individuals with underlying risk factors.

Preventing Disease with Data

Preventing disease with data is at the heart of Springbuk’s mission. Springbuk recently introduced an Insights™ category to identify individuals at risk of having undiagnosed CKD, using a model that was developed by Bang et al, and originally published in JAMA Internal Medicine as its foundation.  A risk calculator for undiagnosed CKD based on this model is available on the CDC website.

Springbuk also provides information on gaps in care used to monitor high-risk populations and members identified with CKD.

Powered with information, employers can:

• Engage with care management, disease management programs, and on-site or near-site clinics to close gaps in care
• Encourage high-risk members to discuss screening tests with their PCPs
• Provide education to high-risk and identified members related to lifestyle changes to reduce risk of onset or progression of CKD

Insights at Your Fingertips

Chronic kidney disease is an insidious disease that can lead to renal failure, high costs, and potentially death. Predictive modeling and gaps in care are two tools offered by Springbuk that can be used to identify individuals who may have undiagnosed CKD, allowing earlier detection and interventions that may slow progression.