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Czupryniak L, Mosenzon O, Rychlík I, Clodi M, Ebrahimi F, Janez A, Kempler P, Małecki M, Moshkovich E, Prázný M, Sourij H, Tankova T, Timar B. Barriers to early diagnosis of chronic kidney disease and use of sodium-glucose cotransporter-2 inhibitors for renal protection: A comprehensive review and call to action. Diabetes Obes Metab 2024. [PMID: 39140231 DOI: 10.1111/dom.15789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Revised: 05/08/2024] [Accepted: 06/26/2024] [Indexed: 08/15/2024]
Abstract
Chronic kidney disease (CKD) affects approximately 13% of people globally, including 20%-48% with type 2 diabetes (T2D), resulting in significant morbidity, mortality, and healthcare costs. There is an urgent need to increase early screening and intervention for CKD. We are experts in diabetology and nephrology in Central Europe and Israel. Herein, we review evidence supporting the use of sodium-glucose cotransporter-2 (SGLT2) inhibitors for kidney protection and discuss barriers to early CKD diagnosis and treatment, including in our respective countries. SGLT2 inhibitors exert cardiorenal protective effects, demonstrated in the renal outcomes trials (EMPA-KIDNEY, DAPA-CKD, CREDENCE) of empagliflozin, dapagliflozin, and canagliflozin in patients with CKD. EMPA-KIDNEY demonstrated cardiorenal efficacy across the broadest renal range, regardless of T2D status. Renoprotective evidence also comes from large real-world studies. International guidelines recommend first-line SGLT2 inhibitors for patients with T2D and estimated glomerular filtration rate (eGFR) ≥20 mL/min/1.73 m2, and that glucagon-like peptide-1 receptor agonists may also be administered if required for additional glucose control. Although these guidelines recommend at least annual eGFR and urine albumin-to-creatinine ratio screening for patients with T2D, observational studies suggest that only half are screened. Diagnosis is hampered by asymptomatic early CKD and under-recognition among patients with T2D and clinicians, including limited knowledge/use of guidelines and resources. Based on our experience and on the literature, we recommend robust screening programmes, potentially with albuminuria self-testing, and SGLT2 inhibitor reimbursement at general practitioner (GP) and specialist levels. High-tech tools (artificial intelligence, smartphone apps, etc.) are providing exciting opportunities to identify high-risk individuals, self-screen, detect abnormalities in images, and assist with prescribing and treatment adherence. Better education is also needed, alongside provision of concise guidelines, enabling GPs to identify who would benefit from early initiation of renoprotective therapy; although, regardless of current renal function, cardiorenal protection is provided by SGLT2 inhibitor therapy.
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Affiliation(s)
- Leszek Czupryniak
- Department of Diabetology and Internal Medicine, Medical University of Warsaw, Warsaw, Poland
| | - Ofri Mosenzon
- Diabetes Unit, Department of Endocrinology and Metabolism, Hadassah Medical Centre, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
- Regeneron Pharmaceuticals, Tarrytown, New York, USA
| | - Ivan Rychlík
- Department of Internal Medicine, Third Faculty of Medicine, Charles University, Prague, Czech Republic
- University Hospital Královské Vinohrady, Prague, Czech Republic
| | - Martin Clodi
- Hospital of Internal Medicine Brüder Linz, Linz, Austria
- Institute for Cardiovascular and Metabolic Research (ICMR), Johannes Kepler Universität Linz (JKU Linz), Linz, Austria
| | - Fahim Ebrahimi
- University Digestive Health Care Centre Basel-Clarunis, Basel, Switzerland
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Andrej Janez
- Department of Endocrinology, Diabetes and Metabolic Diseases, Medical Centre, University of Ljubljana Medical Faculty, Ljubljana, Slovenia
| | - Peter Kempler
- Department of Medicine and Oncology, Semmelweis University, Budapest, Hungary
| | - Maciej Małecki
- Department of Metabolic Diseases, Jagiellonian University Medical College, Kraków, Poland
| | - Evgeny Moshkovich
- Diabetes and Endocrinology Clinic, Clalit Medical Services, Ramat Gan, Israel
| | - Martin Prázný
- 3rd Department of Internal Medicine, 1st Faculty of Medicine, Charles University in Prague, Prague, Czech Republic
| | - Harald Sourij
- Interdisciplinary Metabolic Medicine Trials Unit, Division of Endocrinology and Diabetology, Medical University of Graz, Graz, Austria
| | - Tsvetalina Tankova
- Department of Endocrinology, Medical University - Sofia, Sofia, Bulgaria
| | - Bogdan Timar
- Second Department of Internal Medicine, "Victor Babes" University of Medicine and Pharmacy, Timisoara, Romania
- Centre for Molecular Research in Nephrology and Vascular Disease, "Victor Babes" University of Medicine and Pharmacy, Timisoara, Romania
- Diabetes Clinic, "Pius Brinzeu" Emergency Hospital, Timisoara, Romania
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Norhammar A, Bodegard J, Eriksson JW, Haller H, Linssen GCM, Banerjee A, Karasik A, Mamouris P, Tangri N, Taveira‐Gomes T, Maggioni AP, Botana M, Thuresson M, Okami S, Yajima T, Kadowaki T, Birkeland KI. Cost of healthcare utilization associated with incident cardiovascular and renal disease in individuals with type 2 diabetes: A multinational, observational study across 12 countries. Diabetes Obes Metab 2022; 24:1277-1287. [PMID: 35322567 PMCID: PMC9321691 DOI: 10.1111/dom.14698] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 03/07/2022] [Accepted: 03/20/2022] [Indexed: 12/15/2022]
Abstract
AIM To examine how the development of cardiovascular and renal disease (CVRD) translates to hospital healthcare costs in individuals with type 2 diabetes (T2D) initially free from CVRD. METHODS Data were obtained from the digital healthcare systems of 12 nations using a prespecified protocol. A fixed country-specific index date of 1 January was chosen to secure sufficient cohort disease history and maximal follow-up, varying between each nation from 2006 to 2017. At index, all individuals were free from any diagnoses of CVRD (including heart failure [HF], chronic kidney disease [CKD], coronary ischaemic disease, stroke, myocardial infarction [MI], or peripheral artery disease [PAD]). Outcomes during follow-up were hospital visits for CKD, HF, MI, stroke, and PAD. Hospital healthcare costs obtained from six countries, representing 68% of the total study population, were cumulatively summarized for CVRD events occurring during follow-up. RESULTS In total, 1.2 million CVRD-free individuals with T2D were identified and followed for 4.5 years (mean), that is, 4.9 million patient-years. The proportion of individuals indexed before 2010 was 18% (n = 207 137); 2010-2015, 31% (361 175); and after 2015, 52% (609 095). Overall, 184 420 (15.7%) developed CVRD, of which cardiorenal disease was most frequently the first disease to develop (59.7%), consisting of 23.0% HF and 36.7% CKD, and more common than stroke (16.9%), MI (13.7%), and PAD (9.7%). The total cumulative cost for CVRD was US$1 billion, of which 59.0% was attributed to cardiorenal disease, 3-, 5-, and 6-fold times greater than the costs for stroke, MI, and PAD, respectively. CONCLUSION Across all nations, HF or CKD was the most frequent CVRD manifestation to develop in a low-risk population with T2D, accounting for the highest proportion of hospital healthcare costs. These novel findings highlight the importance of cardiorenal awareness when planning healthcare.
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Affiliation(s)
- Anna Norhammar
- Cardiology Unit, Department of MedicineSolna, Karolinska InstituteStockholmSweden
- Capio St Görans HospitalStockholmSweden
| | | | - Jan W. Eriksson
- Department of Medical Sciences, Clinical Diabetes and MetabolismUppsala UniversityUppsalaSweden
| | - Hermann Haller
- Division of NephrologyHannover Medical SchoolHannoverGermany
| | | | - Amitava Banerjee
- Institute of Health InformaticsUniversity College LondonLondonUK
- Department of CardiologyUniversity College London HospitalsLondonUK
| | - Avraham Karasik
- Maccabi Institute for Research and InnovationMaccabi Healthcare ServicesTel AvivIsrael
| | | | - Navdeep Tangri
- Department of Medicine and Community Health SciencesUniversity of ManitobaWinnipegCanada
| | - Tiago Taveira‐Gomes
- Department of Community Medicine, Information and Decision in HealthFaculty of Medicine, University of PortoPortoPortugal
| | - Aldo P. Maggioni
- ANMCO Research CentreFlorenceItaly
- Maria Cecilia HospitalGVM Care and ResearchCotignolaItaly
| | - Manuel Botana
- Endocrinology ServiceLucus Augusti University HospitalLugoSpain
| | | | | | | | | | - Kåre I. Birkeland
- Department of Transplantation MedicineOslo University Hospital and University of OsloOsloNorway
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