Chronic kidney disease (CKD)

Overview

Recognition

Many people have no symptoms until the kidney disease is very advanced.

Assessment

Blood and urine tests, including eGFR and the urine albumin-to-creatinine ratio, are used to find and follow it.

Burden

No burden claims are published.

Claims and evidence

No claims are published for this condition yet.

Clinical links

Each link reports what one cited claim says about one population. "Evaluated for" means studied, not shown to work. These links do not show that anything is effective or right for you.

• Claim, not a settled fact Evaluated for this: Estimated glomerular filtration rate (eGFR) (Evaluated for, seen from the other side)

  Applies to Adult

  • Adults with chronic kidney disease, or at higher risk of it, for example because of diabetes or high blood pressure.
  • Not stated; patient information pages
  • Not stated; United States federal health agencies
  • Adults

  Follow-up Not applicable (descriptive page)
  MedlinePlus says eGFR and mGFR tests are used to see if the kidneys are filtering waste at a healthy rate. An eGFR test is used to screen for kidney disease in people without symptoms, to help diagnose it in people who have symptoms, to help find out how serious kidney disease is, and to monitor people being treated for chronic kidney disease. The page says the provider can find eGFR by measuring creatinine levels, for example in a basic metabolic panel.

  Limitations. A patient-information page from the National Library of Medicine. The passages read give no eGFR values or stage thresholds, so this atlas gives none.

• Claim, not a settled fact Evaluated for this: Urine albumin-to-creatinine ratio (UACR) (Evaluated for, seen from the other side)

  Applies to Adult

  • Adults with chronic kidney disease, or at higher risk of it, for example because of diabetes or high blood pressure.
  • Not stated; patient information pages
  • Not stated; United States federal health agencies
  • Adults

  Follow-up Not applicable (descriptive page)
  MedlinePlus says a microalbumin creatinine ratio urine test checks the level of the protein albumin in the urine, and that abnormal amounts may be an early sign of kidney disease. It is most often used to look for signs of kidney disease in people who have a high risk of developing it but no symptoms, for example people with diabetes or high blood pressure. It may also be used to monitor the kidneys of people who have been diagnosed with kidney disease. The page says that anyone with diabetes should be tested for kidney disease every year.

  Limitations. A patient-information page from the National Library of Medicine. The passages read give no ratio thresholds, so this atlas gives none. The threshold used for entry differs between trials and is given on each trial record.

• Claim, not a settled fact Risk raised by: Type 2 diabetes (Associated with a higher risk of, seen from the other side)

  Applies to Adult

  • Adults with chronic kidney disease, or at higher risk of it, for example because of diabetes or high blood pressure.
  • Not stated; patient information pages
  • Not stated; United States federal health agencies
  • Adults

  Follow-up Not applicable (descriptive page)
  The NIDDK chronic kidney disease page says that diabetes and high blood pressure are the most common causes of chronic kidney disease in adults. The MedlinePlus chronic kidney disease summary says the same.

  Limitations. Patient-information pages. Both pages say diabetes without separating type 1 from type 2, so this atlas does not claim the statement is specific to type 2 diabetes. The pages give no size of the risk.

• Claim, not a settled fact Evaluated for this: Dapagliflozin (Evaluated for, seen from the other side)

  Applies to Adult

  • Participants with chronic kidney disease, an eGFR of 25 to 75 ml per minute per 1.73 m2 and a urinary albumin-to-creatinine ratio of 200 to 5000. People with and without type 2 diabetes were included.
  • Multicenter trial. The care setting is not described further in the sources read.
  • Multinational. The registry lists the sites by country on the study page.
  • Adults aged 18 years or older (registry minimum age 18 years)

  Follow-up Median follow-up 2.4 years. The independent data monitoring committee recommended stopping the trial because of efficacy.
  In DAPA-CKD, 4304 participants with chronic kidney disease, with or without type 2 diabetes, were randomly assigned to dapagliflozin 10 mg once a day or placebo. The independent data monitoring committee recommended stopping the trial because of efficacy. Over a median of 2.4 years, the primary outcome (a sustained eGFR decline of at least 50%, end-stage kidney disease, or death from renal or cardiovascular causes) occurred in 197 of 2152 participants (9.2%) on dapagliflozin and 312 of 2152 (14.5%) on placebo (hazard ratio 0.61; 95% CI 0.51 to 0.72; P<0.001; number needed to treat to prevent one primary event 19, 95% CI 15 to 27). The kidney composite had a hazard ratio of 0.56 (0.45 to 0.68) and cardiovascular death or heart-failure hospitalization 0.71 (0.55 to 0.92). Death occurred in 101 participants (4.7%) against 146 (6.8%) (hazard ratio 0.69; 0.53 to 0.88). Effects were similar in participants with and without type 2 diabetes, and the known safety profile of dapagliflozin was confirmed.

  Limitations. The trial was stopped on the monitoring committee recommendation for efficacy. The abstract does not list adverse event numbers. Funded by AstraZeneca (named in the abstract). Only the PubMed abstract was read. The claim is about dapagliflozin as tested in this one trial; it does not pool the other dapagliflozin trials, which sit in other claims.

• Claim, not a settled fact Evaluated for this: Empagliflozin (Evaluated for, seen from the other side)

  Applies to Adult

  • Patients with chronic kidney disease who had an eGFR of at least 20 but less than 45 ml per minute per 1.73 m2, or an eGFR of at least 45 but less than 90 with a urinary albumin-to-creatinine ratio of at least 200. People with and without diabetes were included.
  • Multicenter international trial (registry official title). The care setting is not described further in the sources read.
  • Multinational. The registry lists the sites by country on the study page.
  • Adults aged 18 years or older (registry minimum age 18 years)

  Follow-up Median follow-up 2.0 years. The trial was stopped early for efficacy at a formal interim analysis.
  In EMPA-KIDNEY, 6609 patients with chronic kidney disease at risk of progression were randomly assigned to empagliflozin 10 mg once a day or matching placebo. Over a median of 2.0 years, kidney disease progression or death from cardiovascular causes occurred in 432 of 3304 patients (13.1%) on empagliflozin and 558 of 3305 (16.9%) on placebo (hazard ratio 0.72; 95% CI 0.64 to 0.82; P<0.001). Results were consistent in patients with and without diabetes and across the eGFR ranges studied. Hospitalization from any cause was lower on empagliflozin (hazard ratio 0.86; 95% CI 0.78 to 0.95; P=0.003). There were no significant differences in the composite of hospitalization for heart failure or death from cardiovascular causes (4.0% against 4.6%) or in death from any cause (4.5% against 5.1%). The full text, in the PMC copy, gives the hazard ratio for death from cardiovascular causes alone as 0.84 (95% CI 0.60 to 1.19). Serious adverse events were similar in the two groups.

  Limitations. The trial was stopped early for efficacy at a formal interim analysis, according to the PMC full text. The PMC copy is a CC BY-ND article, quoted briefly. Funded by Boehringer Ingelheim, Eli Lilly and others (named in the abstract). The claim is about empagliflozin as tested in this one trial; it does not pool the other empagliflozin trials, which sit in other claims.

• Claim, not a settled fact Evaluated for this: Finerenone (Evaluated for, seen from the other side)

  Applies to Adult

  • Patients with chronic kidney disease and type 2 diabetes who had a urinary albumin-to-creatinine ratio of 30 to below 300, an eGFR of 25 to below 60 and diabetic retinopathy, or a ratio of 300 to 5000 and an eGFR of 25 to below 75. All were treated with renin-angiotensin system blockade adjusted to the maximum label dose they tolerated.
  • Multicenter trial. The care setting is not described further in the sources read.
  • Multinational. The registry lists the sites by country on the study page.
  • Adults aged 18 years or older (registry minimum age 18 years)

  Follow-up Median follow-up 2.6 years.
  In FIDELIO-DKD, 5734 patients with chronic kidney disease and type 2 diabetes, all on maximum tolerated renin-angiotensin system blockade, were randomly assigned to finerenone or placebo. During a median follow-up of 2.6 years, the primary outcome (kidney failure, a sustained decrease of at least 40% in eGFR from baseline, or death from renal causes) occurred in 504 of 2833 patients (17.8%) on finerenone and 600 of 2841 (21.1%) on placebo (hazard ratio 0.82; 95% CI 0.73 to 0.93; P=0.001). The key secondary outcome (death from cardiovascular causes, nonfatal heart attack, nonfatal stroke or hospitalization for heart failure) occurred in 367 patients (13.0%) and 420 (14.8%) (hazard ratio 0.86; 95% CI 0.75 to 0.99; P=0.03). Overall adverse events were similar in the two groups, but stopping the trial regimen because of high potassium (hyperkalemia) was more frequent on finerenone, 2.3% against 0.9%.

  Limitations. Participants had to be on renin-angiotensin system blockade and had diabetic kidney disease, so the result does not cover people without diabetes or without that blockade. Funded by Bayer (named in the abstract). Only the PubMed abstract was read.

• Claim, not a settled fact Evaluated for this: Semaglutide (Evaluated for, seen from the other side)

  Applies to Adult

  • Patients who have both type 2 diabetes and chronic kidney disease, defined by an eGFR of 50 to 75 ml per minute per 1.73 m2 with a urinary albumin-to-creatinine ratio above 300 and below 5000, or an eGFR of 25 to below 50 with a ratio above 100 and below 5000. The registry gives a minimum age of 18 years.
  • Multicenter trial. The care setting is not described further in the sources read.
  • Multinational. The registry lists the sites by country on the study page.
  • Adults aged 18 years or older (registry minimum age 18 years)

  Follow-up Median follow-up 3.4 years, after early cessation of the trial was recommended at a prespecified interim analysis.
  In FLOW, 3533 patients who had both type 2 diabetes and chronic kidney disease were randomly assigned to semaglutide 1.0 mg once a week or placebo (1767 and 1766 patients). Over a median of 3.4 years, the risk of the primary outcome, a composite of kidney failure, at least a 50% drop in eGFR, or death from kidney-related or cardiovascular causes, was 24% lower on semaglutide (331 against 410 first events; hazard ratio 0.76, 95% CI 0.66 to 0.88; P=0.0003). The kidney-specific components together had a hazard ratio of 0.79 (95% CI 0.66 to 0.94) and death from cardiovascular causes 0.71 (0.56 to 0.89). All confirmatory secondary outcomes favored semaglutide, including major cardiovascular events (0.82; 0.68 to 0.98) and death from any cause (0.80; 0.67 to 0.95). Serious adverse events were reported in 49.6% of the semaglutide group and 53.8% of the placebo group.

  Limitations. The trial was stopped early: the abstract says early cessation was recommended at a prespecified interim analysis, and it does not give the reason in the sentence read. The dose tested was 1.0 mg weekly, not the 2.4 mg used in SELECT. Funded by Novo Nordisk (named in the abstract). Only the PubMed abstract was read.

Record details

Record id

cardio:chronic-kidney-disease

Content hash

e101278cd8b3a4484d45e4396b8f09544705657bdec64eb10577e241d86c5aef