Chronic kidney disease: the role of early detection in a pathology that affects nearly 5 million Argentines

Every second Thursday in March, the world kidney day, a pathology considered silent because, usually, it does not show symptoms until it is in an advanced phase and is already irreversible, according to experts. In the Argentinathe Ministry of Health said it affects almost 5 million people and that only 1 in 10 is aware.

There Chronic renal failure (CKD) is the progressive loss of kidney function which, in its last phase, develops as renal failure and the consequent need for functional replacement by replacement therapies (RTS), such as dialysis or transplantation. Being asymptomatic, for a long time, the diagnosis is usually late, and it begins to be treated when it is no longer possible to stop its progression and it is only a treatment to alleviate the symptoms.

Currently, according to data from the Pan American Health Organization (PAHO), due to its high incidence, prevalence, morbidity and mortality, it is the eighth leading cause of death in the world . Additionally, the Global Burden of Disease (GBD), in 2019, indicated that it affects more than 720 million people worldwide and produces 1.48 million deaths per year.

In this context, the Instituto Nacional Central Único Coordinador de Ablación e Implante (INCUCAI) and the Argentine Society of Nephrology presented a signed agreement between the two organizations for the development of the Comprehensive Approach Program for Advanced Chronic Kidney Diseasethat is, when it is in the most critical phase, with the aim of working together for the proper care of this group of patients.

In this sense, the nephrologist carlos castellaro underlined, during a conference on chronic kidney disease organized with the support of the biopharmaceutical company Boehringer Ingelheimthat “the highest prevalence (of CKD) occurs at stage G3a (mild to moderate CKD), a stage in which the kidneys show mild or moderate damage and where appropriate intervention strategies can slow the process and delay the start of renal replacement therapy or dialysis.

Likewise, he affirmed that “health strategies must aim at prevention and early diagnosis, which can be done by a simple blood and urine test, which is very inexpensive but not always included in the balance sheets (creatinine and albuminuria).” .

CRF is classified into 5 stages based on glomerular filtration volume (GFR) and the presence of urinary albuminuria. Stage 5, kidney failure, represents a tipping point: From then on, patients need some type of replacement therapy, such as dialysis or a transplant, to continue living. It should be noted that the patient undergoing dialysis undergoes a significant impact on his quality of life.

Health economist Natalia Jorgensen, lead author of the study “CKD in Argentina. Current situation and cost estimate” carried out by “Soul Consulting”, he pointed out during the said conference with experts that “based on in-depth interviews that we have conducted with leading specialists on the subject, we have detected that in Argentina there are gaps in the way of approaching CKD”.

“The turning point is the moment of detection of the disease. When screening is late, patients are more likely to have a poor prognosis and healthcare costs increase,” adds the specialist. Likewise, he warned that the total direct cost of CKD in Argentina is $2,150 million in 2022, and the burden of treating a patient requiring dialysis (stage 5) is 20 times greater. higher than if the intervention was carried out in the previous stages.

With this data in mind, the owner of INCAI, Carlos Sorattigave details of the program and warned that it foresees the creation of Advanced Chronic Kidney Disease Clinics (CERCAs) which will be made up of transdisciplinary teams and will function as an “organizational tool capable of early contact with the insufficiency renal in order to improve the quality of access to substitution treatment when necessary”, as reported by the Ministry of Health in a press release.

He also explained that A national registry of advanced chronic kidney disease will be generated in the National Information System on Supply and Transplantation of the Argentine Republic, which “will allow comprehensive treatment of kidney problems and contribute to improving the quality of the intervention”. And to specify: “The registers allow us to measure the problems and to chart the way for us to intervene, modify and improve the quality and access to substitution treatments”.

carlos bonanopresident of the Argentine Society of Nephrology, spoke about this new program and warned that the motto of the meeting held on the occasion of International Kidney Day was: “Kidney health for all. Prepare for the unexpected, support the most vulnerable! “The experience of the pandemic has made the situation of kidney patients visible” so “we must take advantage of this experience to strengthen the system”, he added.

As detailed, based on the results of the National Nutrition and Health Survey 2018-2019, it is estimated that 12.7% of the adult population (over 18 years old) would suffer from chronic kidney disease at one of its stages, and 2.7% would study advanced chronic kidney disease (ACKD) (stages 3b, 4 and 5). Among this population, the health system has nominalized and registered in the National Information System on Supply and Transplantation of the Argentine Republic (SINTRA) only those patients who are on chronic dialysis and/or on the waiting list. for transplantation.

In this tone, it was explained that the information provided annually by the Argentine Registry of Chronic Dialysis (RADC) on “the clinical conditions with which patients with ACKD arrive for chronic dialysis, explains the lack of timely care by the health services and the conditioning of the prospects of therapeutic success to be achieved”. He even pointed out that “the registry shows the lack of development of peritoneal dialysis and the limited exploration of preventive transplantation in the country”.

With these data, which have been established thanks to the information provided by SINTRA, “we know that only 19% of chronic dialysis patients are registered on the transplant waiting list, and in the particular case of the population with exclusive public coverage only 13%,” reads the statement. While noting that, as part of the agreement, the creation of the Comprehensive Approach Program for Advanced Chronic Kidney Disease is established to promote the detection, staging, registration and comprehensive management of people with ACKD.

At the chronic kidney disease conference sponsored by biopharmaceutical company Boehringer Ingelheim, experts warned against Close relationship between type II diabetes, the kidney and the heart. It is that, as they indicated, among the common causes of CKD are type 1 diabetes, type II diabetes, high blood pressure and glomerular nephritis, according to available data from the GBD.

They also highlighted, thanks to the data provided by the study carried out by the firm Soul Consulting, the importance of Diabetes as the main cause of CKDsince type II causes more than 50% of incident cases of chronic kidney disease, but they also found a close relationship between chronic kidney disease (CKD) and cardiovascular (CV) disease.

“CV disease is the leading cause of death in patients with CKD, but CKD also increases the risk of death from CV disease, independent of the existence of other risk factors,” they said in the document.

In this regard, Dr. Silvia Lapertosa, former president of the SAD (Argentine Diabetes Society), highlighted the importance of this “interconnection between the conditions of type II diabetes, chronic kidney disease and cardiovascular disease, she has been taken into consideration by the Nation’s Ministry of Health for the update of the “diabetes law” which it carried out in November by resolution 2820/2022″.

Within the framework of the said standard, the drugs of the ISGLT2 category (Empagliflozin, Dapagliflozin, Canagliflozin) have been integrated into the Mandatory Medical Program (with 100% coverage) for patients with type II diabetes who meet certain criteria, among them, who have Cardiovascular disease and/or diabetic nephropathy 2 .

“The dimension of the problem should leave room for a necessary discussion in Argentina on the global approach to this chronic disease. This can be achieved with the proactive involvement of various actors in the health system, because if this is not done, the disease will continue to progress silently for the patient and the costs for the health system will continue to increase,” said concluded Jorgensen.

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