High burden and unmet patient needs in chronic kidney disease

Abstract

Chronic kidney disease (CKD) is a complex debilitating condition affecting more than 70 million people worldwide. With the increased prevalence in risk factors such as diabetes, hypertension, and cardiovascular disease in an aging population, CKD prevalence is also expected to increase. Increased awareness and understanding of the overall CKD burden by health care teams (patients, clinicians, and payers) is warranted so that overall care and treatment management may improve. This review of the burden of CKD summarizes available evidence of the clinical, humanistic, and economic burden of CKD and the current unmet need for new treatments and serves as a resource on the overall burden. Across countries, CKD prevalence varies considerably and is dependent upon patient characteristics. The prevalence of risk factors including diabetes, hypertension, cardiovascular disease, and congestive heart failure is noticeably higher in patients with lower estimated glomerular filtration rates (eGFRs) and results in highly complex CKD patient populations. As CKD severity worsens, there is a subsequent decline in patient health-related quality of life and an increased use of health care resources as well as burgeoning costs. With current treatment, nearly half of patients progress to unfavorable renal and cardiovascular outcomes. Although curative treatment that will arrest kidney deterioration is desired, innovative agents under investigation for CKD to slow kidney deterioration, such as atrasentan, bardoxolone methyl, and spherical carbon adsorbent, may offer patients healthier and more productive lives.

Keywords: disease classification; eGFR; economics; quality of life; treatment.

Figure 1

Health-related quality of life and progression of chronic kidney disease (CKD) by stage. Note: Statistical significance observed for trend within each domain P < 0.001. Adapted from Clin J Am Soc Nephrol. Mujais SK, Story K, Brouillette J, et al. Health-related quality of life in CKD patients: correlates and evolution over time. Copyright. 2009. Abbreviation: KDQOL-36, Kidney Disease Quality of Life – 36.

Figure 2

Health-related quality of life (HRQOL), quality of life (QOL), and progression of chronic kidney disease by glomerular filtration rate. Notes:^amL/min/1.73 m². HRQOL measured by Kidney Disease Quality of Life (KDQOL) – 36; QOL measured by SF-12; EKD: P < 0.0001 for all nondialysis and dialysis only groups; BKD: P = 0.0002 for all nondialysis groups; P < 0.0001 for dialysis only group; SF-12 Physical: P = 0.0001 for all nondialysis groups; P = 0.0002 for dialysis only group. Adapted with permission from Macmillan Publishers Ltd: Kidney Int. Copyright 2005. Abbreviations: BKD, Burden of Kidney Disease, subscale of Kidney Disease Quality of Life; D, dialysis; CKD, chronic kidney disease; EKD, Effects of Kidney Disease; subscale of eGFR, estimated glomerular filtration; KDQOL; SF-12 Physical, Medical Outcomes Study Short Form – 12, physical component; ND, no dialysis.