A path plagued by progression: The chronic kidney disease journey

Chronic kidney disease (CKD) is known as a “silent disease” because as many as 90% of patients don’t realize they have the condition until it has advanced, and it is now becoming a leading cause of death worldwide.^{1, 2} With no known cure, there are over 50 treatment options in the development pipeline for CKD and related illnesses aimed at slowing disease progression through the five stages, which end in kidney failure.

To slow progression to end stage renal disease (ESRD) for the more than 37 million afflicted Americans, researchers have to understand the CKD patient journey, complicated by many comorbid conditions.³ Real-world data (RWD) can help untangle this path.

HealthVerity has curated a dataset consisting of 10 million patients, and growing, with a confirmed medical claims diagnosis from 2017 through 2022 using an expansive list of ICD-10 codes to cover every phase of CKD. As one of the only companies to have access to lab results from both Labcorp and Quest Diagnostics, as well as several other sources, we were able to include lab results for all of these CKD patients and locate an additional nearly 2 million individuals with lab results indicating CKD who do not have corresponding medical claims. The comprehensive dataset includes commercial, Medicare and Medicaid claims, and electronic medical records (EMR). With the EMR data, we are able to include height, weight, body mass index, smoking status, ejection fraction, and diastolic and systolic blood pressure. This ready-made CKD cohort can be applied to a variety of use cases, accelerating research by saving valuable time and resources:

• Easily discover clinical trial participants meeting your specific criteria, such as particular comorbid conditions or certain lab levels
• Seamlessly sync clinical trial participants with their RWD for a longitudinal view of their journey to CKD and potential health events occurring outside of the study
• Quickly conduct a control arm or concurrent study to respond to new questions that may arise, changes in care and contextualize your research
• Continually monitor trial participants to future proof your study and understand the ongoing safety and efficacy after a product is in market

A patient’s progressive path

Understanding how a CKD patient progresses from one stage to the next is important for developing appropriate treatments and RWD can shed light on this journey. Here is one example of a patient journey that might be uncovered:

Pre-CKD but at risk
Medical claims, lab data and EMR find a patient having an annual wellness visit with their primary care physician. While the glomerular filtration rate (eGFR) of 64 indicates kidney function is still normal, other comorbidities of obesity and dyslipidemia indicate a potential risk for CKD in the future. 

Decline detected
At next year’s annual wellness visit, we see that the patient now has another risk factor of hypertension and the eGFR has declined to 60, just barely in the normal range. 

CKD diagnosed
Later, medical claims, EMR and lab data show that the patient saw a nephrologist for diagnostic testing and experienced significant decline. With an eGFR of 46, the patient is now in stage 3 of CKD. 

Protecting the kidneys
With CKD increasing the risk of heart disease and the need to manage the patient’s related hypertension to protect the kidneys, the patient is referred to a cardiologist. The RWD provides an additional diagnosis of coronary artery disease and indicates a eGFR of 40. At this stage, the patient is prescribed a cardiac medication.

Further progression
Another visit to the nephrologist finds the patient has reached stage 4 CKD with a eGFR of 34. The patient is now referred to vascular surgery for a dialysis access placement consultation.

End stage renal disease
Claims and hospital chargemaster data show the patient had an unplanned hospital visit and started emergency dialysis, commonly known as ‘crashing into dialysis,’ as the patient is unprepared to begin this journey. With a eGFR of 11, the patient is now in ESRD. Without a permanent vascular access solution in place due to the emergency start of dialysis, the patient is at greater risk for infection and other complications.

Putting the pieces together to stop the progression

March is National Kidney Month, a time when the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) is encouraging people to follow their kidney health to better understand their risks of CKD and protect them from further damage. RWD can help researchers follow the CKD patient journey. The comprehensive CKD dataset that HealthVerity has pre-assembled pulls together the many pieces of the CKD patient journey to better understand disease progression and develop appropriate treatments to preserve kidney function. 

Click here to learn more about the HealthVerity CKD dataset and see a demo.

¹ National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). National Kidney Month 2023. https://www.niddk.nih.gov/health-information/community-health-outreach/national-kidney-month.
 ² Kovesdy, C.P. (2022). Epidemiology of chronic kidney disease: an update 2022. Kidney International Supplements. 2022 Apr; 12(1): 7-11. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9073222/.
³  NDDKD. What is Chronic Kidney Disease. https://www.niddk.nih.gov/health-information/kidney-disease/chronic-kidney-disease-ckd/what-is-chronic-kidney-disease.