Impact of Delayed or Missing Diagnosis of Chronic Kidney Disease
Author(s)
Nicole Fusco, ScD1, James Weatherall, PhD2, Jayne Hurrell, MA3, Maria Koufopoulou, MSc3.
1Cencora, Conshohocken, PA, USA, 2Boehringer Ingelheim International GmbH, Ingelheim am Rhein, Germany, 3Cencora, London, United Kingdom.
1Cencora, Conshohocken, PA, USA, 2Boehringer Ingelheim International GmbH, Ingelheim am Rhein, Germany, 3Cencora, London, United Kingdom.
OBJECTIVES: Patients in the early stages of chronic kidney disease (CKD) often experience few or no symptoms and may therefore remain undiagnosed until their condition progresses. Lack of clinical diagnoses may delay initiation of treatment to slow progression. Our research aimed to identify evidence on the screening and diagnosis of CKD, as well as potential impacts of delayed diagnosis.
METHODS: A targeted literature review was conducted in Embase to identify publications presenting information on the screening and diagnosis of CKD. Articles were screened against prespecified eligibility criteria, and the most relevant and robust studies were identified for synthesis.
RESULTS: Although the Kidney Disease: Improving Global Outcomes guidelines recommend CKD screening for patients with relevant comorbidities, 17-33% of patients with hypertension, diabetes, and/or cardiovascular disease did not receive appropriate renal testing. Diagnosis rates among patients with laboratory values indicating CKD vary significantly across and within disease stages but are consistently low, particularly in earlier stages. Factors associated with higher diagnosis rates were male sex, presence of comorbidities, more advanced stages of the disease, and younger age. Receipt of a diagnosis was associated with significantly increased monitoring (albuminuria, creatinine, and blood pressure) and prescription fill rates, as well as significantly slower annual decline of estimated glomerular filtration rate (eGFR). Delayed diagnosis was significantly associated with increased risk of kidney failure and cardiac outcomes including myocardial infarction, stroke, and hospitalization for heart failure. In addition, all-cause healthcare costs among late-stage CKD patients were significantly lower in patients with a previous, lower-stage diagnosis.
CONCLUSIONS: Earlier diagnosis of CKD allows timely intervention to slow progression, improving clinical outcomes and decreasing costs. However, most early-stage CKD patients, as well as many later-stage CKD patients, are not diagnosed, despite having relevant laboratory data available. Efforts should be made to increase albuminuria screening and diagnosis rates, facilitating earlier initiation of effective treatment.
METHODS: A targeted literature review was conducted in Embase to identify publications presenting information on the screening and diagnosis of CKD. Articles were screened against prespecified eligibility criteria, and the most relevant and robust studies were identified for synthesis.
RESULTS: Although the Kidney Disease: Improving Global Outcomes guidelines recommend CKD screening for patients with relevant comorbidities, 17-33% of patients with hypertension, diabetes, and/or cardiovascular disease did not receive appropriate renal testing. Diagnosis rates among patients with laboratory values indicating CKD vary significantly across and within disease stages but are consistently low, particularly in earlier stages. Factors associated with higher diagnosis rates were male sex, presence of comorbidities, more advanced stages of the disease, and younger age. Receipt of a diagnosis was associated with significantly increased monitoring (albuminuria, creatinine, and blood pressure) and prescription fill rates, as well as significantly slower annual decline of estimated glomerular filtration rate (eGFR). Delayed diagnosis was significantly associated with increased risk of kidney failure and cardiac outcomes including myocardial infarction, stroke, and hospitalization for heart failure. In addition, all-cause healthcare costs among late-stage CKD patients were significantly lower in patients with a previous, lower-stage diagnosis.
CONCLUSIONS: Earlier diagnosis of CKD allows timely intervention to slow progression, improving clinical outcomes and decreasing costs. However, most early-stage CKD patients, as well as many later-stage CKD patients, are not diagnosed, despite having relevant laboratory data available. Efforts should be made to increase albuminuria screening and diagnosis rates, facilitating earlier initiation of effective treatment.
Conference/Value in Health Info
2025-11, ISPOR Europe 2025, Glasgow, Scotland
Value in Health, Volume 28, Issue S2
Code
EPH134
Topic
Epidemiology & Public Health
Disease
Urinary/Kidney Disorders