Nephrologists Urge Active Search for Chronic Kidney Disease

BERLIN — In Germany, more than 10 million people have chronic kidney disease (CKD), a severe and irreversible condition that leads to a progressive loss of kidney function. In the end stage, patients rely on regular dialysis or a kidney transplant, and as kidney function decreases, cardiovascular risk also greatly increases. Three out of four patients are unaware of their condition, partly because as much as 90% of kidney function loss can occur without symptoms, according to the German Society of Nephrology (DGfN).

CKD can be detected early with two simple tests using blood and urine samples. But early detection is not always achieved, as Dr Julia Weinmann-Menke, director of the Clinic for Nephrology, Rheumatology, and Kidney Transplantation at the University Medical Center Mainz in Germany, emphasized during the press conference at the 16th Annual Meeting of the DGfN in Berlin. “CKD is a disease that requires active seeking,” she said. Weinmann-Menke is also a spokesperson for the DGfN. Yet, the “disappointing data” from the recently published InspeCKD study indicate that this CKD is sought far too rarely, she said.

Effective Medications Available

Only 45.5% of high-risk patients had their estimated glomerular filtration rate (eGFR) determined in their primary care physician’s office, according to the data. Only 7.9% of patients received a test for albumin using test strips, and the quantitative determination of albumin excretion in urine was determined in only 0.4% of affected patients. Even in the presence of high-risk factors such as type 2 diabetes or high blood pressure, albumin excretion in urine and eGFR are often not measured.

A simple blood and cost-effective urine test, where eGFR and protein levels in urine are determined by a primary care physician, “have a high prognostic value and can help ensure that patients heading toward severe kidney disease are identified and treated early,” said Weinmann-Menke. The fact that this identification rarely happens is “tragic as effective medications have been available for several years that can delay or even halt the progression of CKD, especially in early stages,” she added. CKD must be diagnosed in a timely manner.

To promote early diagnosis and therapy, the DGfN calls for the inclusion of these cost-effective examinations in primary care and internal medicine practice.

New Treatments

Nephrological research has been stagnant for decades, said Dr Martin K. Kuhlmann, head of the Clinic for Nephrology at Friedrichshain Hospital in Berlin and president of the DGfN. Besides renin-angiotensin-aldosterone system blockade, there has been no therapy for slowing the progression of CKD or treating specific kidney diseases such as glomerulonephritis.

But new medication options have changed the field of nephrology, stressed Kuhlmann. With SGLT-2 inhibitors, the mineralocorticoid receptor antagonist finerenone, and the upcoming approval of GLP-1 receptor agonists, therapy options are now available that slow down kidney function loss.

Slowing Disease Progression

SGLT-2 inhibitors were originally developed as oral antidiabetic agents, but they were found to have positive effects on the heart and kidneys. Kuhlmann reported that various studies had shown that SGLT-2 inhibitors can significantly slow the progression of kidney function loss. In the current Kidney Disease: Improving Global Outcomes (KDIGO) guideline, the use of these medications is recommended for all patients with diabetes and CKD, provided that kidney function is still above 20 mL/min/1.73 m².

Also effective in preventing the progression of diabetic kidney disease is the new nonsteroidal, selective mineralocorticoid receptor antagonist finerenone, as shown by the results of the FIDELIO study. Finerenone is intended to reduce the formation of proinflammatory and profibrotic substances, thus slowing the progression of CKD. The KDIGO guideline recommends the use of this class of substances in patients with diabetes mellitus and albuminuria (albumin-creatinine ratio > 30 mg/g).

New Cornerstone of Treatment?

Another new therapy option is the so-called weight loss injection. Weight reduction reduces the risk for secondary diseases such as high blood pressure, which leads to kidney diseases. It also has been shown that semaglutide slows the progression of kidney disease in patients with diabetes mellitus. In addition to protecting the kidneys by improving high blood pressure, blood sugar levels, and obesity, semaglutide directly inhibits inflammatory processes in kidney cells, thereby protecting the kidneys of patients without diabetes mellitus.

Semaglutide could become a new pillar in the treatment of kidney diseases, according to Kuhlmann.

“With these treatments, the prognosis of patients for cardiovascular diseases can also be improved” because both diseases are related, said Weinmann-Menke.

The new medications, according to Kuhlmann, will change medical practice. Early detection and screening of kidney function not only make sense, but also should become mandatory, he said.

The KDIGO guideline recommends screening certain high-risk patients for kidney disease. “This population includes patients with diabetes and cardiovascular diseases, obesity, known kidney diseases in the family, and previous kidney damage,” said Weinmann-Menke.

Screening for Everyone

“The inclusion of kidney diseases in the Healthy Heart Act (GHG) would be a crucial step in improving early detection, reducing heart attacks and strokes, and ultimately lowering healthcare costs,” said Weinmann-Menke. So far, the kidneys have not been included in the GHG, despite the DGfN’s statements, participation in the hearing of the Federal Ministry of Health, and intensive media contributions highlighting the critical absence of CKD in the GHG.

Because CKD can be treated better when it is detected earlier, the DGfN argues for fundamental screening to be part of health examinations that are paid for by statutory health insurance from the age of 35 years.

This story was translated from the Medscape German edition using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.