Major health risks associated with untreated chronic kidney disease

A person cleans a patient's arm folds before a blood test.

Patients with early-stage chronic kidney disease are often not recognised by the healthcare system, which means that they are neither diagnosed nor treated, regardless of whether they have diabetes or not. This is according to a research study from Uppsala University Hospital. According to the researchers, the main reason is that doctors do not react to signs of impaired kidney function in blood tests. Mostphotos

Patients with early-stage chronic kidney disease (CKD) often go unrecognised by health services, resulting in a lack of diagnosis and treatment, whether they have diabetes or not. Missing out on kidney protection treatment increases the risk of hospitalisation and 15% of patients die within a year. This is according to an international research study led by Uppsala University Hospital and Uppsala University.

Portrait of Maria Eriksson Svensson.

Maria Eriksson Svensson, Senior Consultant in Renal Medicine at Uppsala University Hospital and Professor at Uppsala University.

"The fact that early-stage chronic kidney disease is often not recognised by the healthcare system means that patients are neither diagnosed nor treated to protect their kidneys. The study also shows that patients who do not have concurrent diabetes are less likely to be treated. Our results also show that kidney-protective treatment is not started sufficiently upon diagnosis," says Maria Eriksson Svensson, senior physician in renal medicine at Uppsala University Hospital and Professor at Uppsala University.

The main reason for the lack of diagnosis and treatment, she says, is that doctors do not react to signs of reduced kidney function in blood tests. This is because the condition is asymptomatic and not associated with serious risks. Chronic kidney disease is often referred to as the silent disease because the symptoms often come on the sly. According to Maria Eriksson Svensson, it can take several years before anyone notices anything and by then kidney function can be reduced by half or more.

The prevalence of chronic kidney disease is increasing globally due to an ageing population and the rising prevalence of diabetes, obesity and cardiovascular disease, which, along with kidney inflammation, are the main risk factors.

Maria Eriksson Svensson has led the Swedish part of the OPTIMISE-CKD study, which included patients from Sweden, Japan and the US. The study has used data from the healthcare system in these countries during the period 2016-2023. The aim was to map the care of over 400,000 patients with moderate kidney function impairment and to describe the clinical risks for this group of patients.

She points out that it is common for kidney disease to be linked to diabetes, but the study shows that this is the case for only 20 per cent of patients.

"The absence of diabetes in a newly discovered patient with chronic kidney disease may mean that the risk of serious disease is considered lower. This may explain why the condition receives less attention from both doctors and patients, with the result that patients are less likely to be diagnosed and less likely to receive adequate treatment. However, the increased risk of serious complications and death (according to the study, 15% of patients die within a year) does not depend on having diabetes or non-diabetes status. Therefore, the presence of diabetes should not be the decisive factor for follow-up," she emphasises.

Maria Eriksson Svensson emphasises that primary care has an important role in ensuring that renal impairment is investigated at early symptoms such as elevated blood pressure and fatigue.

It is particularly important to monitor patients with high blood pressure, cardiovascular disease and diabetes, but also patients without diabetes. This is done by a combination of urine tests, blood tests and by measuring blood pressure.

"Today, combinations of old and new medicines, known as RAS blockers and SGLT2 inhibitors, have been shown to be effective in slowing the progression of kidney disease and preventing early death. Early detection is crucial for the prognosis of chronic kidney disease. Loss of kidney function is almost impossible to recover, but it is possible to maintain function through medication and lifestyle changes," concludes Maria Eriksson Svensson.

The scientific article is accepted in the journal Kidney 360.

Fakta

Chronic kidney disease (CKD)

  • Defined as the presence of abnormal changes in the structure and/or function of the kidneys lasting more than three months.
  • The incidence is increasing globally due to an ageing population and increasing prevalence of diabetes, obesity and cardiovascular disease, which, along with kidney inflammation, are the main risk factors.
  • In Sweden, one in ten people have some type of kidney disease.
  • It is estimated that by 2040, one in five deaths worldwide will be related to kidney dysfunction.

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