Real-world evidence highlights the urgent need to act on the growing global burden of chronic kidney disease

First multinational study to assess prevalence of undiagnosed Stage 3 disease reveals up to 97% of patients remain undiagnosed

AstraZeneca, a leader in cardiorenal diseases, presented new real-world evidence (RWE) data at the European Renal Association (ERA) 2023 Congress in Milan, Italy, demonstrating the staggeringly low rate of diagnosis in chronic kidney disease (CKD). These data show that an urgent need exists for improved screening which can lead to earlier diagnosis.

Results from the REVEAL-CKD multinational study showed that the prevalence of undiagnosed Stage 3 (moderate) CKD was 85% to 97% across Spain, Australia, Canada and Brazil. Undiagnosed Stage 3 CKD also remained high in patients with comorbidities who are at high risk of disease progression as findings showed it was 75% to 92%.¹

The implications of this evidence data are reinforced by other recently published results from the REVEAL-CKD study, which show the benefits of recording a diagnosis at Stage 3, as it can help to slow kidney health decline with a significant decrease in estimated glomerular filtration rate (eGFR) decline, highlighting the need for earlier screening in at-risk populations.² Delaying the diagnosis of Stage 3 CKD by one year resulted in an increase in disease progression to Stage 4 or 5 by 40% and the risk of needing a kidney transplant or long-term dialysis treatment by 63%, which are indicators of kidney failure. ²

A separate patient-level simulation forecast model of CKD data ranging from 2022 to 2032, titled The growing burden of chronic kidney disease in UK: an IMPACT-CKD analysis, aims to quantify the impact of the growing burden of CKD. The findings revealed that patients with CKD receiving renal replacement therapy (RRT) are projected to increase by 44% by 2032. As a result, the associated cost of RRT is expected to increase almost 70% to £1.85bn. In addition to the significant clinical burden and direct costs, CKD is also associated with extensive productivity loss. Over the 10-year time period, CKD is projected to result in 81.60 million missed workdays in diagnosed patients, and 11.89 million missed workdays by caregivers of patients with CKD.³

These RWE studies form part of AstraZeneca’s broader Accelerating Change Together (ACT) on CKD programme, which reinforces the Company’s commitment to driving better understanding of CKD and expanding earlier detection to improve patient outcomes. Several papers have already been published showing an opportunity to advance clinical practice, while the programme has also piloted screening programmes in countries across the world in a primary care setting in order to increase early diagnosis. Since the launch of ACT on CKD in 2021, we estimate that we have supported the screening of over 32 million at-risk people and helped over 10 million CKD patients be diagnosed globally.

Ruud Dobber, Executive Vice-President, BioPharmaceuticals Business Unit, AstraZeneca, said: “These new real-world evidence data presented at ERA 2023 build on existing research to paint a stark picture: chronic kidney disease is a global public health emergency that needs to be tackled immediately. The REVEAL-CKD study is the first to show both the vast underdiagnosis of chronic kidney disease, as well as the clear clinical benefits of identifying the disease early. Through our ACT on CKD programme, we aim to help transform care for patients with chronic kidney disease through earlier diagnosis and optimisation of guideline directed medical therapy, to achieve better outcomes and improve lives.”

Notes

CKD 
CKD is a serious, progressive condition defined by decreased kidney function (shown by reduced eGFR or markers of kidney damage, or both, for at least three months).⁴ Nearly 850 million people worldwide are affected by CKD,⁵ with the majority undiagnosed.⁴ The most common causes of CKD are diabetes, hypertension and glomerulonephritis.⁶ CKD is associated with significant patient morbidity and an increased risk of cardiovascular (CV) events, such as heart failure (HF), which drives premature death.⁷ In its most severe form, known as kidney failure, kidney damage and deterioration of kidney function have progressed to the point where dialysis or kidney transplantation are required.⁸ The majority of patients with CKD will die from CV causes before reaching kidney failure.⁹ 

ACT on CKD
ACT on CKD is a programme by AstraZeneca to transform kidney health through partnerships aimed at reducing the proportion of patients progressing to kidney failure by 20% by 2025. To realise this ambition, the programme supports initiatives that aim to raise awareness of the burden of CKD and its consequences, expand early detection and drive optimisation of treatment to improve patient outcomes. To further support people at risk of CKD, we also look to achieve sustainable change through health policy reforms.

We want to provide patients, healthcare providers (HCPs) and decision makers with the necessary information to drive change. As a part of our broader contribution to building knowledge around CKD we continue to generate evidence to help advance clinical practice: DISCOVER-CKD shows a lack of urine albumin-creatinine ratio (UACR) testing and adherence to Kidney Disease Improving Global Outcomes (KDIGO) guidelines; REVEAL-CKD shows the extent of the gaps in early detection of CKD and the clear benefits of diagnosing early; INSIDE-CKD shows the unsustainable future burden of CKD and potential benefits to the healthcare system of improved management; PACE-CKD shows CKD is associated with a poorer quality of life not only for patients but also their carers; and IMPACT CKD provides modelling of the future CKD burden for public health policy planning, including societal and environmental impact.

AstraZeneca in CVRM
Cardiovascular, Renal and Metabolism (CVRM), part of BioPharmaceuticals, forms one of AstraZeneca’s main disease areas and is a key growth driver for the Company. By following the science to understand more clearly the underlying links between the heart, kidneys and pancreas, AstraZeneca is investing in a portfolio of medicines for organ protection and improving outcomes by slowing disease progression, reducing risks and tackling co-morbidities. The Company’s ambition is to modify or halt the natural course of CVRM diseases and potentially regenerate organs and restore function, by continuing to deliver transformative science that improves treatment practices and CV health for millions of patients worldwide.

AstraZeneca
AstraZeneca (LSE/STO/Nasdaq: AZN) is a global, science-led biopharmaceutical company that focuses on the discovery, development, and commercialisation of prescription medicines in Oncology, Rare Diseases, and BioPharmaceuticals, including Cardiovascular, Renal & Metabolism, and Respiratory & Immunology. Based in Cambridge, UK, AstraZeneca operates in over 100 countries and its innovative medicines are used by millions of patients worldwide. Please visit astrazeneca.com and follow the Company on Twitter @AstraZeneca.

References

1.  Pecoits-Filho R, et al. Reveal-CKD: Prevalence Of Undiagnosed Stage 3 Chronic Kidney Disease In Australia, Brazil, Canada And Spain. Presented at: ERA 2023, 15-18 June 2023, Milan, Italy.

2.  Tangri, et al. Patient Management and Clinical Outcomes Associated with a Recorded Diagnosis of Stage 3 Chronic Kidney Disease: The REVEAL-CKD Study. Adv Ther. 2023; 2023; 40:2869-2885.

3.  Sanchez J, et al. The Growing Burden Of Chronic Kidney Disease In UK: An IMPACT CKD Analysis. Presented at: ERA 2023, 15-18 June 2023, Milan, Italy.

4.  Bikbov B, et al. Global, regional, and national burden of chronic kidney disease, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet. 2020;395(10225):709-733.

5.  Jager KJ, et al. A single number for advocacy and communication-worldwide more than 850 million individuals have kidney diseases. Nephrol Dial Transplant. 2019;34(11):1803-1805.

6.  National Kidney Foundation [Internet]. Chronic Kidney Disease (CKD); [cited 2023 June 6]. Available from: https://www.kidney.org/atoz/content/about-chronic-kidney-disease

7.  Centers for Disease Control and Prevention (CDC) [Internet]. Chronic Kidney Disease: Common - Serious - Costly; [cited 2023 June 6]. Available from: https://www.cdc.gov/kidneydisease/prevention-risk/CKD-common-serious-costly.html.

8.  Centers for Disease Control and Prevention (CDC) [Internet]. Chronic kidney disease in the United States; 2021 [cited 2023 June 6]. Available from: https://www.cdc.gov/kidneydisease/pdf/Chronic-Kidney-Disease-in-the-US-2021-h.pdf.

9.  Briasoulis A, et al. Chronic kidney disease as a coronary artery disease risk equivalent. Curr Cardiol Rep. 2013;15(3):340.