Connecting CKD: The link with diabetes
Dr Marie Ludlow & Breonny Robson explain the interrelated and sinister relationship between diabetes and chronic kidney disease, and how YOU can help reduce the burden on our health system and limit unnecessary ill-health for your patients.
Diabetic kidney disease (or diabetic nephropathy as it’s often called) occurs when the filters in the kidneys are damaged as a result of uncontrolled diabetes. Nerve damage is another common consequence of diabetes, affecting many parts of the body including the bladder, making it difficult to pass urine. If urine builds up in the bladder, the pressure can make it to flow back into the kidneys causing scarring and kidney damage. Treatment strategies for these disease states need to recognise and reflect that the conditions frequently co-exist and accelerate the progression of one another, often without overt symptoms.
CKD usually develops over a number of years and, with early identification and management, the disease can be slowed... This presents an opportunity to save both dollars in the health system and unnecessary ill-health for patients.
According to the NEFRON study3, every second patient that visits their general practitioner with type 2 diabetes will have chronic kidney disease (CKD). CKD is regarded as a silent killer , as up to 90% of kidney function can be lost before any symptoms appear. It is therefore essential that primary care practitioners are aware that diabetes is a significant risk factor for CKD, and they are able to detect compromised kidney function and manage it appropriately.
CKD usually develops over a number of years and, with early identification and management, the disease can be slowed, and progression to dialysis or transplantation can be significantly delayed or prevented. This presents an opportunity to save both dollars in the health system and unnecessary ill-health for patients.
Necessarily there are a variety of supports that need to be in place. These are both for the individual and also for their carers. The GP is an important part of the team. For some GPs this can seem daunting and beyond their remit. This is not the case.
Annual checks for kidney disease (known as a Kidney Health Check) in primary care are a critical component of reducing the burden of diabetic kidney disease. The 2011 KinD report4 concluded that annual kidney function screening for people with type 2 diabetes aged 50-69 would result in more than 14,500 years of healthy life gained, more than 1,800 lives saved and more than 1,350 fewer people requiring dialysis or kidney transplant as a result of early diagnosis and treatment to avoid end-stage kidney disease. A Kidney Health Check requires just three simple tests – blood test for creatinine and eGFR, urine test for albumin creatinine ratio, and a blood pressure measurement.
The good news is there is something that you can do! Identify people in your practice with diabetes or other risk factors for CKD (see www.kidney.org.au/your-kidneys/prevent/risk-factors), recall them and perform a Kidney Health Check. If you need some more information, complete the educational module ‘Diabetes and chronic kidney disease: a sinister combination’ available at www.thinkgp.com.au/kha
- Diabetes Australia. Diabetes - The Facts. Diabetes Australia, http://www.diabetesaustralia.com.au/PageFiles/1615/the%20facts%20DA%20FI... [accessed 16 July 2012]; 2011.
- ANZDATA. The 39th ANZDATA Registry Report. Australia and New Zealand Dialysis and Transplant Registry, South Australia, Adelaide; 2016.
- Thomas MC, Weekes AJ, Broadley OJ, Cooper ME, Mathew TH. The burden of chronic kidney disease in Australian patients with type 2 diabetes (the NEFRON study). Med J Aust 2006;185(3):140-4.
- Deloitte Access Economics. Two of a KinD (Kidneys in Diabetes): The burden of diabetic kidney disease and the cost effectiveness of screening people with type 2 diabetes for chronic kidney disease. Kidney Health Australia, http://www.kidney.org.au/LinkClick.aspx?fileticket=LtRF8q7Oys0%3d&tabid=... [accessed 16 July 2012]; 2011.
Breonny Robson BMedSc
Breonny Robson is the National Primary Care Education Manager for Kidney Health Australia. Breonny has worked in health for the last 13 years and is responsible for the delivery of a national program that aims to support best practice detection and management of kidney disease, incorporating comprehensive clinical education and resources, the development and publication of position statements, peer-reviewed articles, guidelines and advocacy. In her spare time she enjoys spending time with her family. For more information on Kidney Health Australia visit www.kidney.org.au
Dr Marie Ludlow is the General Manager Clinical Directorate at Kidney Health Australia. She has a PhD in social sciences and cardiac surgery, and over 20 years of experience in health research and programs. For the past 12 years Marie has worked in the clinical programs unit of Kidney Health Australia, and has managed initiatives such as the National Chronic Kidney Disease (CKD) Strategy, the CKD Management in General Practice guidelines booklet, and the Australasian Creatinine and Proteinuria Consensus processes. In her spare time she enjoys taxiing her children to their various sporting games and running a few kilometres herself.