Berlin – In Germany, more than 10 million people suffer from chronic kidney disease (CKD). CKD is a serious and irreversible disease that leads to progressive loss of kidney function. In the final stage, those affected are dependent on regular dialysis or a kidney transplant; this also increases as kidney function decreases cardiovascular risk strong. However, many of those affected – 3 out of 4 patients, according to the German Society for Nephrology (DGfN) – know nothing about their disease, also because up to 90% of the loss of kidney function can occur without symptoms.
CKD is a disease to look for. Prof. Dr. Julia Weinmann-Menke
CKD could be detected early with 2 simple tests using blood and urine samples. Could. The reality is different, how Prof. Dr. Julia Weinmann-MenkeDirector of the Clinic for Nephrology, Rheumatology and Kidney Transplantation (NTX) at the University Hospital Mainz, made it clear at the press conference on the occasion of the 16th annual meeting of the German Society for Nephrology eV (DGfN) in Berlin [1]. “CKD is a disease that you have to look for,” said Weinmann-Menke, who is also a spokeswoman for the DGfN. But this happens far too rarely, as the “sobering data” recently published shows InspeCKD Study showed.
Early diagnosis is important because effective medications are available
The eGFR value was determined in the family doctor’s office in only 45.5% of the patients at risk. Only 7.9% of patients received an albumin determination using test strips, and the UACR (quantitative determination of albumin excretion in the urine) was only determined in 0.4% of those affected. And even in the presence of high-risk factors such as type 2 diabetes or high blood pressure, albumin excretion in urine and the estimated glomerular filtration rate (eGFR) in the blood are often not determined.
For several years now, effective medications have finally become available with which we can delay or even stop the progression of CKD, especially in the early stages. Prof. Dr. Julia Weinmann-Menke
A simple blood and inexpensive urine test, in which the eGFR and the protein levels in the urine are determined by the family doctor, “has a high prognostic value and can ensure that people who are heading towards serious kidney disease are identified and treated in a timely manner “explained Weinmann-Menke. The fact that this only rarely happens in reality is “tragic, because effective medications have finally been available for several years with which we can delay or even stop the progression of CKD, especially in the early stages,” said Weinmann-Menke. To do this, CKD must be diagnosed in good time.
In order to take advantage of the opportunities for early diagnosis and therapy, the DGfN calls for these cost-effective examinations to be anchored in primary care and internal medicine care.
Hope for the kidneys: SGLT2 inhibitors, weight loss injections & Co.
Prof. Dr. Martin K. KuhlmannHead of the Clinic for Nephrology, Klinikum im Friedrichshain, Berlin and President of the DGfN, recalled that nephrological research has been standing still for decades. Apart from the RAAS blockade (renin-angiotensin-aldosterone system), there has been no therapy for decades to specifically treat the progression of chronic kidney disease and specific kidney diseases, the so-called glomerulonephritides.
New drug therapy options have changed the world of nephrology, emphasized Kuhlmann. With the SGLT-2 inhibitors, the mineralocorticoid receptor antagonist finerenone and the impending approval of the GLP-1 receptor agonists, therapy options that slow down the loss of kidney function are available for the first time.
SGLT-2 inhibitors and Finerenone slow the loss of kidney function
SGLT-2 inhibitors were developed as oral antidiabetic agents. But it turned out that they also have positive effects on the heart and kidneys. Kuhlmann reported that different Studies have impressively shown that SGLT-2 inhibitors can significantly slow the progression of kidney function loss. In the current guidelines According to KDIGO (Kidney Disease: Improving Global Outcomes), the use of these medications is recommended for all people with diabetes and chronic kidney disease (CKD) – but the prerequisite is that kidney function is still above 20 ml/min/1.73 m2 .
Also effective in preventing the progression of diabetic kidney disease is the new, non-steroidal, selective mineralocorticoid receptor antagonist finerenone – as the results show FIDELIO Study have shown. Finerenone is said to reduce the formation of pro-inflammatory and pro-fibrotic substances and thus slow the progression of CKD. The KDIGO guidelines recommend the use of this class of substances in patients with diabetes mellitus and albuminuria (albumin-creatinine ratio/ACR >30 mg/g).
Semaglutide: New pillar in the treatment of kidney disease?
Another new therapy option is the so-called weight loss injection. Not only does losing weight reduce the risk of secondary diseases such as high blood pressure, which leads to kidney disease. It has also recently been shown that semaglutide prevents progression of kidney disease in kidney disease patients with diabetes mellitus slowed down. In addition to protecting the kidneys by improving high blood pressure, blood sugar levels and obesity, inhibits Semaglutide direct Inflammatory processes in kidney cells, so it also protects the kidneys of people without diabetes mellitus.
According to Kuhlmann’s assessment, semaglutide could therefore become a new pillar in the treatment of kidney diseases. “These treatments can also improve the prognosis of those affected for cardiovascular diseases,” reminded Weinmann-Menke. Because both diseases are related.
The new drugs, says Kuhlmann, will change medical practice. Because early detection and screening of kidney function not only makes sense, it should become mandatory. Now, who should be screened for CKD? In the KDIGO guidelines There is a recommendation to examine certain people at risk for kidney disease. “These primarily include diabetes and cardiovascular diseases, obesity, known kidney diseases in the family, previous kidney damage,” says Weinmann-Menke.
DGfN supports screening for everyone and inclusion in the GHG
“The inclusion of kidney diseases in the Healthy Heart Act (GHG) would be a crucial step to improve early detection, reduce heart attacks and strokes and reduce health care costs in the long term,” said Weinmann-Menke. So far, however, the kidneys have not been taken into account in the GHG, although the DGfN has intensively pointed out the critical absence of CKD in the GHG through statements, participation in the hearing of the Federal Ministry of Health (BMG) and media articles.
Because CKD can be treated better the earlier it is detected, the DGfN advocates general screening from the age of 35 as part of the health examinations paid for by statutory health insurance companies.
