Reinforcing the need for early testing and increased communications for patients diagnosed with Chronic Kidney Disease Associated with Type 2 Diabetes
• Chronic kidney disease (CKD) is a silent killer, without any symptoms in the early stage. CKD, an incurable disease, can lead to kidney failure and requires continuous treatments. The common cause is malfunctions caused by diabetes and high blood pressure.
• 1 out of 10 people has kidney disease but 9 in 10 have shown no symptom. CKD is found in one third of patients with diabetes.
• Experts urge risk groups especially patients with diabetes to take an annual kidney test determine the urine albumin: creatinine ratio (uACR)* and/or an annual blood test to determine the estimated glomerular filtration rate (eGFR)*. Treatments are recommended for people with irregularities, to slow progression and prevent the needs for dialysis or kidney transplant that can affect patients’ quality of life and financial conditions.
Dr. Chaicharn Deerochanawong, President of The Endocrine Society of Thailand said: “Diabetes is caused by abnormal sugar levels in our blood. The diabetes can affect multiple organs and lead to complications including chronic kidney disease (CKD) which is a main cause of end-stage kidney failure. Patients will need dialysis or kidney transplants. In developing nations, the prevalence of kidney failure among patients with diabetes is 10 times higher than among people without diabetes.”
Living with a Disease in Thailand
Thailand has 6.1 million patients with diabetes and 42.9% of patients with type 2 diabetes are found with high urine albumin: creatinine ratio (uACR) and 6% of them see progressions and require dialysis. They develop symptoms and face a high mortality rate. One fourth of CKD patients with Type 2 Diabetes (T2D) may experience kidney failure in the 10th year and 49% may die at 10 years.
In the early stage, the patients will show no symptoms. Thus, tests are important, to allow treatments at the early stage before subsequent complications. For those without irregular findings, they are recommended to take tests concerning the retina, protein creatinine in urine and kidney functions once a year. More frequent tests are recommended for those with complications.
Treating CKD to Minimize Cardiovascular Events
Prof. Rungroj Krittayaphong, President of Heart Failure Society of Thailand, said that the risk of heart and cardiovascular disease among patients with T2D is 2 - 4 times higher than people without diabetes. Patients with T2D also have risk of developing a myocardial infarction as patients with previous myocardial infarction without diabetes. People living with T2D are two times more likely to die from cardiovascular disease compared to non-diabetics. T2D and CKD are related and result to undesirable outcomes. The 10-year accumulated incidence of heart and cardiovascular disease shows that the mortality is 6 times higher than people without T2D or people without CKD. Moreover, the risk of people with both T2D and CKD is 2-3 times higher than people with either T2D or CKD.
CKD and heart failure are caused by diabetes, obesity and high blood pressure which are risk factors associated with a progressive disease process and will ultimately cause their death.
Vuddhidej Ophascharoensuk, M.D., President of the Nephrology Society of Thailand, added that diabetes is one of the most common causes of kidney disease. Globally, 843 million people are suffering from CKD and it is the cause of mortality and morbidity. About 1 million died of untreated CKD. In Asia, 434 million people have CKD and 65.6 million or 15% are in the advanced stage. The prevalence and mortality has doubled in the past two decades.
CKD has affected patients’ living quality. Patients experience limited physical mobility and depression. Aside from pain and fatigue, they suffer from an increasing financial burden. In Thailand, about 9 million people or 17.5% of population has kidney disease at various stages, costing the healthcare system 20 billion baht in 2022.
Dr. Vuddhidej said that what is worrisome is 9 in 10 kidney patients do not know their condition and 1 in 3 adult patients with diabetes are diagnosed of CKD. Patients with diabetes thus need to watch out for symptoms that initially may not have any symptoms or only mild symptoms such as blood pressure increase, more frequent urination and foamy urine. If the disease is left untreated, it could lead to kidney failure. The symptoms may be fatigue, insomnia, pale, swollen ankles and feet, and itchy skin and itchy skin. It may cause early stage of cardiovascular disease. They will need Hemodialysis Treatment or Peritoneal Dialysis on a permanent basis or eventually kidney transplant.
New approach for delay progression of kidney failure
Patients with T2D and CKD kidney disease can delay progressions with several therapy options including ACE inhibitors like ARB; SGLT-2inhibitors; GLP-1RA; and nonsteroidal mineralocorticoid receptor antagonist (MRA), a new innovative approach that is different to existing CKD in T2D treatments. The medicine acts by blocking mineralocorticoid receptor (MR) overactivation, which is thought to contribute to CKD progression and cardiovascular damage. Authorization has been granted in several countries including the USA, Europe, India, Singapore, Australia, and Thailand.
The pivotal Phase III clinical trial program of MRA involving more than 13000 patients globally was undertaken to investigate the safety and efficacy of kidney and cardiovascular outcomes in patients with CKD with T2D. The results show that this therapy consistently reduced the risk of the kidney composite outcome.
Early Detection CKD in patients with T2D could save life.
Prof. Dr.Teerapat Yingchoncharoen, Academic Chairman of Heart Failure Society of Thailand, said that in patients with CKD associated with diabetes, slowing kidney and heart disease progression is an important goal. Early diagnosis and treatment to slow the kidney progression as well as lifestyle behavior change can help reduce risk of cardiovascular and kidney complication. Screening and early detection of CKD are believed to produce better health outcomes. Both patients and care givers should realize the importance of medical check-up for early diagnose of CKD in T2D patients to get early treatment. They should take an annual uACR test. As protein does not normally exist in urine, abnormal uACR ratio can indicate the abnormality of kidney function. For example, if the uACR is 30 mg per gram or higher or eGFR is under 60 mL/min/1.73 m² and the condition is left untreated, the patients may develop chronic kidney disease or kidney failure.
Diabetes can lead to complications that affect the physical and financial health of patients and their families. As such, it is extremely important that all must protect themselves against diabetes. They can do so by: 1) having regular annual medical examination; 2) controlling weight through an appropriate intake of healthy food, sugar and saturated fat; 3) regular exercise of at least 150 minutes per week; and 4) avoiding smoking as well as limiting alcohol intake.
Dr. Paneeya Sutabutra, Country Medical Director of Bayer Thai Co., Ltd., said: “Moving forward with Bayer's ongoing commitment to patients with cardiovascular and kidney diseases, we are championing for the urgent diagnosis and effective management of CKD in Thailand, especially for risk groups such as Type 2 Diabetes. As the last stage of kidney failure often puts a heavy toll on the healthcare system and finances, demanding for continuous hemodialysis/peritoneal dialysis or a kidney transplant. To prevent this, patients with diabetes should observe their symptoms early, take both their blood and urine tests for kidney disease at least once a year and consult their doctors to monitor their kidney function.”