High burden and unmet patient needs in chronic kidney disease

Figures & data

Table 1 Classification of chronic kidney disease

Stage	Description	By severity
		eGFR (mL/min/1.73 m^2)	Related terms	By treatment
1	Kidney damage with normal or ↑ eGFR	≥90	Albuminuria, proteinuria, hematuria	“T” for all kidney transplant recipients
2	Kidney damage with mild ↓ eGFR	60–89	Albuminuria, proteinuria, hematuria
3	Moderate ↓ eGFR	30–59	Chronic renal insufficiency, early renal insufficiency
4	Severe ↓ eGFR	15–29	Chronic renal insufficiency, late renal insufficiency, pre-ESRD
5	Kidney failure	<15 (or dialysis)	Renal failure, uremia, ESRD	“D” for all dialysis-treated patients (hemodialysis, peritoneal dialysis)

Adapted by permission from Macmillan Publishers Ltd: Kidney Int.¹⁰⁰ Copyright 2005.

Note: The arrow up indicates increasing eGFR and the arrow down indicates decreasing eGFR.

Abbreviations: ESRD, end-stage renal disease; eGFR, estimated glomerular filtration rate.

Table 2 Common chronic kidney disease (CKD) risk categories and risk factors

Risk category	Risk factors
Susceptibility	Older age, reduction in kidney mass, low birth weight, family history of CKD, US racial or minority status
Initiation	Diabetes, hypertension, autoimmune disease, systemic infections; urinary tract infections, stones, or obstruction; drug toxicity
Progression	Higher proteinuria, hypertension, poor glycemic control in diabetes, smoking, obesity, dyslipidemia, cardiovascular disease, high dietary-protein intake, decreased nephron number
End-stage decline	Lower dialysis dose, temporary vascular access for hemodialysis, anemia, lower serum albumin, late referral to nephrologist, mineral and bone disorders, metabolic acidosis

Note: Modifiable risk factors are presented in bold.

Adapted with permission from Macmillan Publishers Ltd: Kidney Int.¹⁴ Copyright 2007. Other sources: Kronenberg¹⁸; Taal and Brenner⁹⁹; US Renal Data System.⁶¹

Figure 1 Health-related quality of life and progression of chronic kidney disease (CKD) by stage.

Adapted from Clin J Am Soc Nephrol. Mujais SK, Story K, Brouillette J, et al. Health-related quality of life in CKD patients: correlates and evolution over time. Copyright. 2009.⁵¹

Note: Statistical significance observed for trend within each domain P < 0.001.
Abbreviation: KDQOL-36, Kidney Disease Quality of Life – 36.

Figure 2 Health-related quality of life (HRQOL), quality of life (QOL), and progression of chronic kidney disease by glomerular filtration rate.

Notes:^amL/min/1.73 m². HRQOL measured by Kidney Disease Quality of Life (KDQOL) – 36; QOL measured by SF-12; EKD: P < 0.0001 for all nondialysis and dialysis only groups; BKD: P = 0.0002 for all nondialysis groups; P < 0.0001 for dialysis only group; SF-12 Physical: P = 0.0001 for all nondialysis groups; P = 0.0002 for dialysis only group. Adapted with permission from Macmillan Publishers Ltd: Kidney Int.⁴⁸ Copyright 2005.
Abbreviations: BKD, Burden of Kidney Disease, subscale of Kidney Disease Quality of Life; D, dialysis; CKD, chronic kidney disease; EKD, Effects of Kidney Disease; subscale of eGFR, estimated glomerular filtration; KDQOL; SF-12 Physical, Medical Outcomes Study Short Form – 12, physical component; ND, no dialysis.

Table 3 Increased cost by chronic kidney disease (CKD) stage

Country, cost measure (denomination)	Stage 1	Stage 2	Stage 3	Stage 4	Stage 5
USA
Employer, unadjusted total medical payments (US$)^Citation37	–	–	$9727	$19,419	$30,366
Employer, per member per year costs (US$)^Citation62	$5000–$12,000		$15,000–$28,000		Exceeds $70,000
Managed care, annualized total medical costs (US$)^Citation36	–	$7050	$6026	$7623	–
Managed care, annual total health care costs of CKD in specialist clinic and other setting (US$)^Citation58	–	–	$10,132–$14,000	$12,386–$16,545	$18,522–$23,445
Germany
Hospital data, in-hospital costs (€)^Citation33	€2926	€3466	€4208	€9687

Table 4 Current renoprotective drug therapy

Risk factor or comorbid condition and current therapy	Renoprotective effects
Hypertension
Angiotensin-converting enzyme inhibitors	Lower blood pressure
Angiotensin-receptor blockers	Reduce proteinuria
	Slow decline or improved GFR
Dyslipidemia
Statins	Lower cholesterol
	Reduce proteinuria
Hyperglycemia
Insulin	Reduce proteinuria
Insulin sensitizers	Slow decline or improve GFR

Note: Hirsch⁸⁸ and National Kidney Foundation.¹²

Abbreviation: GFR, glomerular filtration rate.

Table 5 Key emergent renoprotective drug therapy

Drug/Phase	Mechanism of action	Sponsor
Bardoxolone methyl (RTA-402) Phase III^Citation90,Citation91	Activation and modulation of Nrf2 (anti-inflammatory effect)	Reata pharmaceuticals
Spherical carbon adsorbent (AST-120) Phase III^Citation92,Citation95	Spherical carbon adsorbent of uremic toxins	Mitsubishi Tanabe Pharma and Kureha
Atrasentan (ABT-627) Phase IIb^Citation93	Blocks effect of endothelin-1	Abbott
CTP-499 Phase I^Citation96	Anti-inflammatory, antioxidant, antifibrotic	Concert pharmaceuticals
VTP-27999 Phase I^Citation97	Selective renin inhibitor	Vitae pharmaceuticals

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