Prevalence of chronic kidney disease in patients with type 2 diabetes admitted to multidisciplinary hospitals: results of a prospective observational multicenter study (CREDO)

AIM: To assess the prevalence of chronic kidney disease (CKD), clinical and demographic characteristics and therapy profile in patients with type 2 diabetes admitted to multidisciplinary hospitals. CREDO (Cardio-REnal Diabetic cOmplications) trial was initiated for this purpose.

MATERIALS AND METHODS: in a prospective observational multicenter study for the period from August 2022 to April 2023, data from 445 patients with type 2 diabetes hospitalized in multidisciplinary hospitals of the Moscow Department of Health were analyzed. The data was collected on a single visit. The design of the study did not involve any interventions in routine clinical practice, including the choice of a diagnostic or treatment method.

RESULTS. The study included 445 patients with the main inclusion criteria — type 2 diabetes, age over 50 years, duration of diabetes more than 3 years. The prevalence of CKD was 90%, while in 43% the diagnosis of CKD was confirmed, in 43% it was detected for the first time, and in 7% the disease progressed. Patients with stage C2 and C3 (a and b), as well as with levels of A1 and A2 albuminuria, were most often identified. The percentage of patients in whom the albuminuria was not performed remained high — 46.2%. The highest incidence of CKD was observed in patients with inadequate glycemic control, having an HbA1c level of ≥9%. In the group with newly diagnosed CKD, sodium-glucose co-transporter-2 inhibitor (iSGLT-2) was received by 31.1% of patients, glucagon-like peptide-1 receptor agonists (GLP-1 RA) — 7.9% of patients. In the group with confirmed CKD — 30.7% and 9.4%, respectively.

CONCLUSION: it has been shown that patients over the age of 50 with type 2 diabetes with a disease duration of more than 3 years are at a high risk of developing CKD — 90%. The results obtained convincingly confirm the possibility of detecting CKD and initiating nephroprotective therapy at the hospital stage.

1. Standards of specialized diabetes care. 11th edition. Ed by Dedov I.I., Shestakova M.V., Mayorov A.Yu. Moscow: 2023. (In Russ.) doi: https://doi.org/10.14341/DM13042

2. Shamkhalova MS, Vikulova OK, Zheleznyakova AV, et al. Trends in the epidemiology of chronic kidney disease in patients with diabetes in Russian Federation according to the Federal diabetes register (2010–2022). Diabetes mellitus. 2023;26(5):404-417. (In Russ.) doi: https://doi.org/10.14341/DM13090

3. Batiushin MM, Kasimova IS, Gavrilov DV, Gysev AV, Gulamov AA. Prevalence of chronic kidney disease according to the retrospective cohort study “CKD epidemiology” (Kirov City). Nephrology and dialysis. 2021;23(2):192-202. (In Russ.) doi: https://doi.org/10.28996/2618-9801-2021-2-192-202

4. Klochkova EV, Tolmacheva AA, Chernova NN, Nikolskaya IN. Diabetic nephropathy and chronic kidney disease in type 2 diabetes. Siberian Medical Review. 2019;(5):29-32. (In Russ.) doi: https://doi.org/10.20333/2500136-2019-5-29-32

5. Xie Y, Bowe B, Mokdad AH, Xian H, Yan Y, et al. Analysis of the Global Burden of Disease study highlights the global, regional, and national trends of chronic kidney disease epidemiology from 1990 to 2016. Kidney Int. 2018;94(3):567-581. doi: https://doi.org/10.1016/j.kint.2018.04.011

6. United States Renal Data System. 2022 USRDS Annual Data Report: epidemiology of kidney disease in the United States. In: National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD; 2022.

7. Gansevoort RT, Correa-Rotter R, Hemmelgarn BR, et al. Chronic kidney disease and cardiovascular risk: epidemiology, mechanisms, and prevention. Lancet. 2013;382 (9889):339–52. doi: https://doi.org/10.1016/S0140-6736(13)60595-4

8. Gavrilova AO, Severina AS, Shamhalova MS, Shestakova MV. The role of advanced glycation end products in patogenesis of diabetic nephropathy. Diabetes mellitus. 2021;24(5):461-469. (In Russ.) doi: https://doi.org/10.14341/DM12784

9. KDIGO CKD Work Group. KDIGO 2012 clinical practice guideline for the evaluation and management of chronic kidney disease. Kidney Int Suppl. 2013;3:1-150. doi: https://doi.org/10.1038/kisup.2012.73

10. Gohda T Murakoshi M. Sodium-Glucose Cotransporter-2 Inhibitors— Miracle Drugs for the Treatment of Chronic Kidney Disease Irrespective of the Diabetes Status: Lessons from the Dedicated Kidney Disease-Focused CREDENCE and DAPA-CKD Trials. Int. J. Mol. Sci. 2022;23:13749. doi: https://doi.org/10.3390/ijms232213749

11. JhaV, Garcia-GarciaG, IsekiK, et al. Chronic kidney disease: global dimension and perspectives. Lancet. 2013;382(9888):260–72. doi: https://doi.org/10.1016/S0140-6736(13)60687-X

12. Batiushin MM. Chronic Kidney Disease: Current State of the Problem. Rational Pharmacotherapy in Cardiology. 2020;16(6):938-947. (In Russ.) doi: https://doi.org/10.20996/1819-6446-2020-11-06

13. Sultan AA, Barone S, Kumar S, et al. 998-P: REVEAL-CKD: Prevalence of and Patient Characteristics Associated with Undiagnosed Stage 3 Chronic Kidney Disease. Diabetes. 2021;70(Supplement_1). doi: https://doi.org/10.2337/db21-998-P

14. Shlipak MG, Tummalapalli SL, BoulwareLE, et al. The case for early identification and intervention of chronic kidney disease: conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) controversies conference. Kidney Int. 2021;99(1):34–47. doi: https://doi.org/10.1016/j.kint.2020.10.012

15. Kidney Disease: Improving Global Outcomes (KDIGO)Blood Pressure Work Group. KDIGO2021 clinical practice guideline for the management of blood pressure in chronic kidney disease. Kidney Int. 2021;99(3s):S1–87. doi: https://doi.org/10.1016/j.kint.2020.11.003

16. Kidney Disease: Improving Global Outcomes (KDIGO) Lipid Work Group. KDIGO clinical practice guideline for lipid management in chronic kidneydisease. KidneyIntSuppl. 2013;3:259–305. doi: https://doi.org/10.1038/kisup.2013.27

17. Rossing P, Caramori ML, Chan JCN, et al. KDIGO 2022 clinical practice guideline for diabetes management in chronic kidney disease. Kidney Int. 2022;102(5):S1–127. doi: https://doi.org/10.1016/j.kint.2022.06.008

18. Draznin B, Aroda VR, Bakris G, et al. Chronic kidney disease and risk management: standards of medical care in diabetes-2022. Diabetes Care. 2022;45(Suppl1):S175–84. doi: https://doi.org/10.2337/dc22-S011

19. Fontes-Carvalho R, Santos-Ferreira D, Raz I, et al. Protective effects of SGLT-2 inhibitors across the cardiorenal continuum: two face soft the same coin. Eur J Prev Cardiol. 2021;29(9):1352–60. doi: https://doi.org/10.1093/eurjpc/zwab034

20. Rangaswami J, Bhalla V, Boer IHD, et al. Cardiorenal protection with the newer antidiabetic agents patients with diabetes and chronic kidney disease: a scientific statement from the American Heart Association. Circulation. 2020;142(17):e265–86. doi: https://doi.org/10.1161/CIR.0000000000000920

21. Tangri N, Moriyama T, Schneider MP, et al. REVEAL-CKD: management and monitoring of patients with stage 3CKD in France, Germany, Italy, Japan and the USA[poster]. Presented at the American Society of Nephrology (ASN) Kidney Week 2022, November 3–6 2022, Orlando, Florida, USA. Chronic kidney disease often undiagnosed in Medic are beneficiaries. 2020. Accessed 22.09.2022. Available at https://www.cms.gov/files/document/ckd-data-highlight102020-2.pdf

22. Bakris G, Coresh J, Vassalotti JA, et al. Prevalence and factors associated with undiagnosed chronic kidney disease in diabetes mellitus. In: National Kidney Foundation. 2019. Spring Clinical Meetings. Boston, MA, USA; 2019.

23. RyanTP, Sloand JA, Winters PC, et al. Chronic kidney disease prevalence and rate of diagnosis. Am J Med. 2007;120(11):981–6. doi: https://doi.org/10.1016/j.amjmed.2007.05.012

24. Greer RC, Crews DC, Boulware LE. Challenges perceived by primary care providers to educating patients abou tchronic kidney disease. J RenCare. 2012;38(4):174–81. doi: https://doi.org/10.1111/j.1755-6686.2012.00323.x

25. Stempniewicz N, Vassalotti JA, Cuddeback JK, et al. Chronic kidney disease test in among primary care patients with type 2 diabetes across 24 US Health Care Organizations. Diabetes Care. 2021;44(9): 2000–9. doi: https://doi.org/10.2337/dc20-2715

26. Alfego D, EnnisJ, Gillespie B, et al. Chronic kidney disease testing among at-risk adults in the US remains low: real-world evidence from national laboratory database. Diabetes Care. 2021;44(9): 2025–32. doi: https://doi.org/10.2337/dc21-0723

27. Holmboe ES, Durning SJ. Assessing clinical reasoning: moving from invitro to in vivo. Diagnosis. 2014;1(1):111–7. doi: https://doi.org/10.1515/dx-2013-0029

28. Paterick TE, Patel N, TajikAJ, et al. Improving health outcomes through patient education and partnerships with patients. Proc (Bayl UnivMed Cent). 2017;30(1):112–3. doi: https://doi.org/10.1080/08998280.2017.11929552

29. Evangelidis N, Craig J, Bauman A, et al. Lifestyle behave our change for prevent in the progression of chronic kidney disease: a systematic review. BMJ Open. 2019;9(10):e031625. doi: https://doi.org/10.1136/bmjopen-2019-031625

30. Jutel A. Sociology of diagnosis: a preliminary review. Sociol Health Illn. 2009;31(2):278-299. doi: https://doi.org/10.1111/j.1467-9566.2008.01152.x

31. O’Malley KJ, Cook KF, Price MD, Wildes KR, Hurdle JF, Ashton CM. Measuring diagnoses: ICD code accuracy. Health Serv Res. 2005. doi: https://doi.org/10.1111/j.1475-6773.2005.00444.x

32. Tangri N, Stevens LA, GriffithJ, et al. A predictive model for progression of chronic kidney disease to kidney failure. JAMA. 2011;305(15):1553–9. doi: https://doi.org/10.1001/jama.2011.451

33. Schneider M, Peach E, Barone S, et al. POS-213 REVEAL-CKD: prevalence of undiagnosed early chronic kidney disease in Germany. Kidney Int Rep. 2022;7(2):S93.

34. KimV, GusmanovA, SakkoY, et al. POS-296 late diagnosis of CKD and associated survival after initationt of renal replacement therapy in Kazakhstan: analysis of nationwide electronic healthcare registry 2014–2020. KidneyIntRep. 2022;7(2):S132–3. doi: https://doi.org/10.1016/j.ekir.2022.01.316

35. Sesso R, Belasco AG. Late diagnosis of chronic renal failure and mortality on maintenance dialysis. Nephrol Dial Transplant. 1996;11(12):2417–20. doi: https://doi.org/10.1093/oxfordjournals.ndt.a027207

36. Greer RC, Crews DC, Boulware LE. Challenges perceived by primary care providers to educating patients about chronic kidney disease. J RenCare. 2012;38(4):174–81. doi: https://doi.org/10.1111/j.1755-6686.2012.00323.x

37. Handelsman Y. Rationale for the early use of sodiumglucose cotransporter-2 inhibitors in patients with type 2 diabetes. Advances in Therapy. 2019;36(10):2567-2586. doi: https://doi.org/10.1007/s12325-019-01054-w

38. Moiseev VC, Mukhin NA, Smirnov AV, et al. Cardiovascular risk and chronic kidney disease: cardio-nephroprotection strategies. Russian Journal of Cardiology. 2014;(8):7-37. (In Russ.) doi: https://doi.org/10.15829/1560-4071-2014-8-7-37