Testing could help save lives: CKD associated with T2D

Interview with Dr Patrick Holmes, General Practitioner Partner, Primary Care Diabetes Society
 

The following educational content has been developed by Bayer and Dr Patrick Holmes. Author: Linda Whitney

uknews45
Chronic kidney disease is a common complication of type 2 diabetes, yet many patients and healthcare practitioners do not understand it.

There are now around 4.4 million people with type 2 diabetes (T2D) in the UK, including an estimated 1 million who are undiagnosed. About one in ten of the over 40s have it – and yet, there is still widespread misunderstanding of the disease’s complications.


“Many people, including some healthcare practitioners, don’t fully appreciate the complications that T2D often leads to,” says Dr Patrick Holmes, a GP who also works alongside the Primary Care Diabetes Society. He explains: “Diabetes is a serious condition where the blood glucose level of the body is too high. Over a long period, high glucose levels can lead to complications, including serious damage to the heart, eyes, feet and kidneys.”


Chronic kidney disease
“Chronic kidney disease (CKD) is already the leading cause of kidney failure in the UK and the leading cause of death among people with T2D,“ says Dr Holmes. Up to 40% of people with T2D could eventually develop CKD, which reduces kidney performance. This can increase the risk of cardiovascular events, such as heart attacks and strokes.


Most CKD symptoms do not appear until it is well-advanced and the rate of death from heart attacks and strokes increases as it progresses. People with T2D who develop CKD early in life can lose up to 16 years of their potential lifespan.


Early detection of CKD associated with T2D is key
There are ways to manage the progress of CKD, including eating healthily, staying fit and controlling blood pressure and blood sugar, plus cholesterol-reducing treatments. But management is more effective if started early.


Importance of testing
For CKD associated with T2D, guidelines recommend using two main tests (eGFR and UACR) together to determine how well the kidneys are functioning and the level of damage (i.e., how much protein is leaking into the urine).


The eGFR (estimated glomerular filtration rate) is measured by a blood test, typically given to patients annually, while the UACR (urine albumin-to-creatinine ratio) requires a urine test, typically administered to only about 60% of patients each year. The two tests should be repeated after three months.


Dr Holmes says: “The shortfall in people with T2D taking the urine test is an issue, because it spots the development of CKD earlier than the blood test. By the time the blood test identifies CKD, about half the potential damage to the kidneys is done – and it cannot be reversed.


“We need more healthcare practitioners and patients to understand the importance of having both tests. Together they can detect CKD and tell us how quickly it will progress. Patients should ask about the tests and ensure they are repeated.”


Next steps
In the past GPs used to refer patients for dialysis once kidney function had dropped to 25% normal capacity, but a new tool called the Kidney Failure Risk Equation (KFRE), used in primary care can help predict which patients need hospital care. It takes into account a patient’s age, gender and the results of the urine and blood tests. Dr Holmes urges patients to ask about it.


A new website that allows patients and healthcare practitioners online access to the KFRE is now open. It’s aimed mainly at people with kidney function below 60% who already know the results of their blood and urine tests, but it can be accessed by anyone. “It tells you your risk of kidney failure in the next two to five years and whether a referral to a kidney specialist should be considered,” says Dr Holmes.


Saving lives, money – and cut carbon footprint
Understanding how to recognise and delay CKD progression in people with T2D can save lives, save money for the NHS from dialysis or transplants and contribute to the NHS’s carbon net zero goal.


“About 80% of the cost of type 2 diabetes to the NHS comes from dealing with complications – CKD is one of the costliest,” says Dr Holmes. “Greater awareness of CKD in type 2 diabetes benefits everyone.”