CKD Often Missed in Type 2 Diabetes - MedPage Today

ORLANDO -- Chronic kidney disease may go undiagnosed in many patients with type 2 diabetes, researchers reported here.

In an analysis of data from 21 states, nearly 90% of type 2 diabetes patients had chronic kidney disease (CKD) that went undiagnosed, Diana Brixner, RPh, PhD, of the University of Utah, and colleagues reported at the National Kidney Foundation meeting.

That "shockingly high" number is in line with several other studies that have shown large proportions of type 2 diabetic patients with undiagnosed kidney disease, Beth Piraino, MD, of the University of Pittsburgh and president of NKF, told MedPage Today. Piraino was not involved in the study.

Diabetes is a major risk factor for the development of CKD, but it often goes undiagnosed in primary care, despite recommendations to screen for markers of renal impairment, Piraino explained.

To estimate the proportion of type 2 diabetes patients who have undiagnosed kidney disease, Brixner and colleagues looked at electronic health records and laboratory results from several medical groups and hospital chains across the U.S., with data on 12 million patients from 21 states, collected between Jan. 1, 2008 and Dec. 31, 2011.

The researchers used laboratory values to determine whether patients had CKD, as well as the stage of that disease. Patients were classified as "undiagnosed" if those lab values indicated CKD, but there was no code for a CKD diagnosis.

Overall the researchers found that 50.7% of patients with type 2 diabetes had any stage of CKD; nearly a quarter (22%) were at a more advanced stage in their disease, ranking at stage 3 to 5.

However, only 12.2% of the overall population with all stages of disease had been diagnosed; 87.8% of these patients had no CKD diagnosis.

A slightly lower proportion (83.6%) of those with stage 2 to 5 disease had gone undiagnosed, and 76.1% of those in the latest stages of disease (3 to 5) never received a diagnosis of CKD despite their labs indicating otherwise.

In the sample, older patients (those over 65) and blacks had a higher prevalence of CKD, but there were no differences in rates of undiagnosed CKD across any subgroups, the researchers added.

They noted that their study was limited because patients may have had healthcare visits outside of the visits captured in this sample, and because the findings may not be generalizable to other healthcare settings.

Still, they concluded that undiagnosed CKD is common among patients with type 2 diabetes, especially among those who have early stages of CKD, and that future studies should look at "the impact of not recognizing renal impairment to understand the needs for proper screening for this population."

Piraino added that her organization has championed an awareness initiative to partner with primary care physicians in order to detect impaired renal function and CKD in this population.

"It is recommended for type 2 diabetes that you do serum creatinine and albumin screening, but it is not being done enough," she said.

Primary source: National Kidney FoundationSource reference:Chen SY, et al "Prevalence of undiagnosed chronic kidney disease in patients with type 2 diabetes mellitus" NKF 2013; Abstract 179.