Welcome to this episode of KD Go Conversations in Nephrology.
This episode, titled Early Detection of CKD, is provided by
KD Go and is supported by an independent educational grant
from AstraZeneca. Here's your host, Doctor Peter
Lynn. Hello and welcome to KD Co
Conversations in Nephrology. I'm Doctor Peter Lynn, Director
of Primary Care Initiatives at the Canadian Heart Research
Center. And family physician in Toronto,
Canada and joining me to discuss the importance of early CKD
detection is Dr. Shrilika Tomapalli.
Dr. Tomapalli is a nephrologist and health services researcher
at Well Cornell Medicine and her clinical and research interests
include population health and health policy in CKD Doctor
Tomapalli. Welcome to the program.
Thank you for having me. It's really good to have you
here and we've been having these discussions about kidneys and we
know that our kidneys rarely complain until they're very
badly damaged. So therefore we have to go
looking for CKD. So who should we be thinking
about when it comes to screening for CKD?
What particular patient populations should we prioritize
CKD screening? The first group I'll mention is
patients with diabetes. So in many high income countries
diabetes accounts for half the cases of end stage kidney
disease and early stage CKD is really prevalent among this
population. So patients with diabetes.
About 1/3 of them have CKD. And so there's several national
and international guidelines that recommend CKD screening
yearly in patients with diabetes.
And it's important to remember that a lot of these patients,
their GFR is normal, but they have elevated albumin area until
the very end. So you know, it's very important
to do both the blood testing as well as the urine testing, the
urine testing for protein and albumin.
Other populations that I'll mention, there's some consensus
that patients with hypertension should be screened for CKD and
with CKD and hypertension we have this bidirectional
relationship. CHF as well causes cardio renal
syndrome and patients with CHF have a high prevalence of CKD.
As well as patients with atherosclerotic cardiovascular
disease, they have a high problems of CKD, so should be
considered for CKD screening. So Hidigo had a controversies
conference in 2019 that you know we both had the opportunity to
participate in on early detection in CKD and the
conclusion of that conference with is that these three
populations, diabetes, hypertension and cardiovascular
disease should be prioritized for CKD screening.
Yeah, that's actually a very easy list to remember because
that's the bulk of our patients that we see on a daytoday basis.
And as you put it, that we have to measure both the blood as
well as the urine. So the e.g.
F are the speed of the kidney. That's what I always tell my
patients, that's the speed of your kidney.
You know how fast it works. And then the albumin in the
urine would tell us about, you know, the leak in the quality of
the filter. So diabetes, hypertension,
cardiovascular disease, that's a big chunk of our daily
population that we see. Are there any other risk factors
or red flags that we should be looking for that might be tied
to higher risk of CKD as well, in addition to diabetes,
hypertension and cardiovascular disease?
Yeah, there are other risk factors.
One is family history of kidney disease.
So for every patient, you know, we should be asking them if they
have family members on dialysis. And that might be due to
diabetes in the family, but there's other genetic factors as
well, you know, collagen mutations, kind of other genetic
factors that are continually being discovered.
So family history also really comes into play with polycystic
kidney disease, which is autosomal dominant.
Inheritance patients with lupus are also at risk for kidney
disease and there's other conditions that pose a risk for
kidney disease as well. So if they have a history of
severe a Ki, if they were hospitalized obesity.
IV drug use, hepatitis and uncontrolled HIV are all risk
factors as well as any patients that are chronically taking
medications that are nephrotoxic.
So like lithium or NSAIDs. And luckily you don't need to
remember this full list. The International Society of
Nephrology has a Quick guide to CKD early identification so you
can find that online and that lists out all these high risk
conditions. And that sounds a really like a
good list that we should keep. And and I think you mentioned
something there that torked my attention which was and SAIDS,
we have so many patients taking and SAIDS and they might not be
telling us. So that's something that we can
ask for. And I must admit I never thought
about family history, how important that is because I can
give you a guide as to whether there's kidney disease within
the family. So those are all very useful
sort of practical tips for those just tuning in.
You're listening to KD Co podcast on early detection of
CKD. I'm Doctor Peter Lynn and I'm
speaking with Doctor Tomapalli. Now CKD is found everywhere in
the world, but what are the differences between countries?
Are there any country specific factors that might affect how we
screen for CKD? Absolutely.
I think in each country the approach to CKD screening really
needs to be tailored to that individual context.
And a lot of especially low and middle income countries, they
have limited access to CKD diagnostic testing.
So some of the more expensive, you know, blood and urine tests.
Some things to keep in mind, there are certain areas that
have a high burden of what's called Ckdu, so CKD of unknown
origin. It's predominantly found in
agricultural areas, sugar cane farming areas where workers are
at risk for dehydration. So this is increasingly found in
many pockets of the world. So definitely if you're in that
type of area, that's something to keep in mind.
And then IGA nephropathy is another one.
It has higher incidence in Japan for instance.
So they adopt A universal population wide screening
policy. So definitely you know, follow
your country specific guidelines and each country might have an
assessment for what makes sense in that particular region.
Yeah, those are good points. In other words, the testing may
not be available and more importantly there may be
different diseases that are more predominant.
I never thought about the different types of diseases that
may be causing CKD would vary across the world as well.
So that's very important. And so that's why you know the
country specific guidelines are so useful as well.
So all of that is very good and this conversation has.
Given me a lot of thought as to what I should be bringing back
to my practice, are there any other things that you want to
give as a final message to our listeners in terms of early
detection and why we should be, you know, focusing in on that
for our CKD patients? Yeah, I think.
You know early detection of CKD is more important today than
ever before because we have so many exciting therapeutics now
we have new medications to treat CKD and delay disease
progression. So you know, I know you'll talk
about those further in a later podcast, but it's really an
exciting time and having all these.
Chances to intervene early and modify the disease course is
really going to help so many patients across the world who
are living with kidney disease. I guess that's very rewarding
right now for you, right. So whereas before we find people
with CKD and dialysis was the sort of the only option, but now
there are lots of medications and things that we could do
before that, right? That must be very rewarding for
you to see that as well. Oh, absolutely.
I think seeing as a nephrologist seeing patients in clinic.
Before, when they would ask you what can I do about my kidney
disease Now we have so many options for them, lifestyle
interventions, medications, you know, not just Ras inhibitors,
but SGLT Two's, Minerallocorticoid receptor
antagonists, GLP one receptor antagonists.
The field is very bright right now.
That's great. That list is a very hopeful list
and that's a great way to round out our discussion today.
So we know that our kidneys are hard workers.
They never complained. So therefore we have to go check
in on them. So that's why early screening
might be a good idea. And you gave us a nice short
list that we can handle. You know, our diabetes patients,
hypertensive patients, cardiovascular disease,
astroscritic cardiovascular disease patients are all people
that we see regularly. So therefore we should screen
them. And you gave us some very good
useful information about family history and the other types of
kidney diseases that we could detect.
Systemic diseases like lupus and these are all things that may be
rare, but if we can find them, as you pointed out, there's so
many things that we could do for those patients once we identify
them. So let's make sure that we
identify them early so that way we can intervene and change the
course of our patients future. I want to thank you, Dr.
Tomapalli, for joining me today and sharing your great insights
and the importance of early detection of CKD.
Thank you very much. Thank you for having me.
I'm Dr. Peter Lynn, signing off. If you'd like to listen to this
or other episodes in our series, please visit kdeco.org/podcasts.
Thanks for listening.