An influential U.S. panel has added screening for chronic kidney disease (CKD) to its list of active preventive services under consideration, the group’s chair told Reuters, a move that could help identify eligible patients for new drugs that previously treated the disease.
The US Preventive Services Task Force (USPSTF) last solved the problem in 2012, finding insufficient evidence for routine screening evaluation of CKD in asymptomatic adults. This conclusion does not reflect the latest science and is now inactive, said Dr. Carol Mangion, chairman of the government-backed panel, in an email.
The change was not announced in any public forum, a USPSTF spokesman confirmed.
A possible update is being driven in part by new drugs that may slow the progression of the disease without any symptoms in the early stages but it can lead to kidney failure, which is fatal without dialysis filtering or kidney transplantation.
“For a screening to help people live longer, healthier lives, physicians must be able to treat the condition if it is found. The existence of effective treatment is one of the many important factors the task force considers,” Manzion said.
A new type 2 diabetes treatment known as the SGLT2 inhibitor, which works by inducing the kidneys to excrete excess blood sugar through urine, has been shown to have separate beneficial effects on the heart and kidneys.
AstraZeneca’s Farxiga won US approval last year for slowing the progression of early stage kidney disease. A major trial of Eli Lilly and Bohringer Ingelheim’s Jardians was discontinued in March after it became clear that the drug was beneficial for patients with kidney disease.
The National Kidney Foundation estimates that 37 million people in the United States have kidney disease, but about 90% do not know they have it. About 800,000 people are living with end-stage kidney disease, requiring dialysis or transplantation to survive.
“Most kidney and cardiovascular diseases are silent … until something happens and then it’s catastrophic,” said Dr. Anjoy Rastogi, director of the Los Angeles Kidney Health Program at the University of California, Los Angeles.
USPSTF recommendations often trigger insurance coverage for testing. Once the panel prioritizes an update of its screening recommendations, it will create a draft plan and post it for public comment. The whole process can take up to three years.
People with conditions such as high blood pressure and diabetes have a higher risk of kidney disease, and several medical societies already recommend screening for their CKD. The Kidney Foundation estimates that diabetes is the leading cause of kidney failure, accounting for about 40% of new cases.
Older drugs, ‘less discomfort’ use
Until recently, the treatment of people initially diagnosed with CKD consisted mainly of decades-old blood pressure medications.
Dr. Katherine Tuttle, a kidney specialist at the University of Washington in Seattle, said that since many cases are undiagnosed, the use of this old drug is “extremely low” in about 25% to 40% of CKD patients.
Farxiga, Jardiance and Johnson & Johnson’s Invokana were previously approved to treat patients with type 2 diabetes, including CKD. A recent study using March 2021 data from a large Boston health center found that only 6% of these patients were given a SGLT2 drug.
“Since people with kidney disease are at risk for both kidney function and heart problems, the availability of further treatment options and relevant education is important,” Eli Lilly said in an email comment.
Kidney disease screening usually consists of a blood test for levels of a substance called creatinine and a urine test for albumin, a type of protein.
“The tests we’re talking about, such as a urine albumin test, $ 10,” Tuttle said, adding that this is not a test that “breaks the healthcare budget.”
But the drugs themselves are expensive, which has led to the cessation of use.
The Forsyth US list price is $ 533 for a 30-day supply, although AstraZeneca emphasizes patient support activities aimed at covering co-drinkers and the uninsured.
“Many of these patients, if left untreated, could undergo dialysis,” said Sarah Walters, head of cardiovascular, renal and metabolism at AstraZeneca. (Edited by Bill Barcroft Reporting by Dinah Basel)