Early chronic kidney disease intervention could save four European health systems up to €15.8 billion over 10 years

IMPACT CKD model is the first study to examine and forecast the vast impact of chronic kidney disease over 10 years

Data across four countries project targeted screening and treatment with guideline-directed therapy can prevent nearly 1.7 million cardiovascular events

Results from the ACT on CKD evidence programme presented at 61st European Renal Association Congress support the need for policy change for chronic kidney disease

New modelling analyses by AstraZeneca suggest that health systems in Germany, the Netherlands, Spain and the United Kingdom can save €15.8 billion over 10 years by implementing early and targeted screening of chronic kidney disease (CKD) in patients with risk factors of type 2 diabetes and hypertension and early use of guideline-directed medical therapies.1 Through earlier diagnosis and treatment, it may be possible to reduce the risk of disease progression and therefore the likelihood of and costs associated with managing potential cardiovascular events.1 Data from IMPACT CKD, the first study to examine and forecast the vast impact of CKD over a 10-year time horizon, was presented at the 61st European Renal Association (ERA) Congress in Stockholm, alongside additional data from the Accelerating Change Together (ACT) on CKD evidence programme, demonstrating the health and economic impacts of the growing global burden of CKD.1-5

Modelling of the four European countries projects that in patients at high risk of CKD, targeted screening and early use of guideline-directed treatment would result in approximately 774,800 fewer heart attacks, 554,400 fewer hospitalisations for heart failure (HHF) events and 338,200 fewer strokes over 10 years, compared to current practice.1 The associated cost savings from reduced clinical events would amount to nearly €15.8 billion over the 10-year period – equivalent to the combined average salaries of over 290,000 hospital nurses across the four countries.1,6

A second analysis of IMPACT CKD data from these European countries further underscores the importance of targeted screening and guideline-directed treatment for patients at high risk of CKD, providing potential clinical benefits for patients in addition to cost savings.2 By implementing these strategies, the analysis forecasted a reduction in the incidence of undiagnosed CKD (stage 1-2: 49.2% to 71.6%, stage 3-5: 60.2% to 69.8%), dialysis (22.6% to 41.9%), cardiovascular events (44.6% to 49.1%) and mortality (4.5% to 9.1%) compared to current practice.2

Professor Steven Chadban, Professor of Renal Medicine at University of Sydney, Australia and investigator on the IMPACT CKD study said: “When left untreated, CKD can have a significant impact on patient health beyond kidney function. Those living with the disease are also at increased risk of cardiovascular complications such as myocardial infarction and heart failure, which share common risk factors like diabetes and hypertension. Proactive and routine screenings in the primary care setting can help identify and manage CKD at earlier stages, with the potential to improve patient outcomes and reduce the costs associated with managing cardiovascular events.”

Real-world evidence from the DISCOVER CKD study was also presented at the ERA Congress.3 Data from patients (n=1052) across the United Kingdom, United States, Spain, Italy, Sweden and Japan show that in addition to screening, treatment of early (Stage 3) CKD plays a pivotal role in reducing the impact of CKD on patients (patient-reported outcomes) and health systems.3 A preliminary analysis shows that during a 12-month follow-up period, patients taking renin-angiotensin-system inhibitors and sodium-glucose co-transporter-2 inhibitors had a 67% lower risk of all-cause mortality (HR 0.33; 95% CI: 0.12-0.80; p=0.019) and a 20% lower risk of all-cause hospitalisation (HR 0.80; 95% CI: 0.64-0.99; p=0.042) compared to patients not receiving kidney-protective medication.3

Multinational survey data from the PaCE CKD trial demonstrate that the burden of CKD not only poses a high cost to economies but can also reduce quality of life for both patients and caregivers.4 Results show that those living with CKD report (n=201) 24% lower scores in surveys assessing overall health status and health-related quality of life compared to the general population.4 In addition to impaired health states, patients also report elevated impairment across work and non-work activities, with increased rates of absenteeism and presenteeism.4 In a second analysis of the PaCE CKD data, caregivers (n=112) reported similar challenges including significantly impaired health states, adverse quality of life, financial problems, and reduced work productivity due to absenteeism and presenteeism.5

Ruud Dobber, Executive Vice-President, BioPharmaceuticals Business Unit, AstraZeneca, added: “The evidence presented at the ERA Congress demonstrates both the urgent need for improved CKD policies and the potential for such changes to lead us toward a brighter future for patients and their loved ones, as well as cost savings for healthcare systems. AstraZeneca remains dedicated to working with policy makers and health systems across the globe to improve access to screening for at-risk patients and guideline-directed treatment for those living with CKD, so they can live fuller, healthier lives.”

The IMPACT CKD, PaCE CKD and DISCOVER CKD studies are part of AstraZeneca’s ACT on CKD initiative, aiming to enhance the understanding and improve outcomes of CKD worldwide. Through the ACT on CKD programme, AstraZeneca, alongside the Global Patient Alliance for Kidney Health (GloPAKH), has launched the ‘Make the Change for Kidney Health’ campaign. This initiative seeks to elevate CKD on the global policy agenda, advocating for comprehensive and effective disease management strategies to combat this escalating health challenge.

Notes

CKD  
Nearly 850 million people worldwide are affected by CKD,7 with the majority undiagnosed.8 The most common causes of CKD are diabetes, hypertension and glomerulonephritis.9 CKD is associated with significant patient morbidity and an increased risk of cardiovascular (CV) events, such as myocardial infarction and heart failure (HF), which drives premature death.10 In its most severe form, known as kidney failure, kidney damage and deterioration of kidney function have progressed to the point where dialysis or kidney transplantation are required.11 The majority of patients with CKD will die before reaching kidney failure.12

ACT on CKD
ACT on CKD is a programme by AstraZeneca to transform kidney health through partnerships aimed at reducing the proportion of patients progressing to kidney failure by 20% by 2025. To realise this ambition, the programme supports initiatives that aim to raise awareness of the burden of CKD and its consequences, expand early detection and drive optimisation of treatment to improve patient outcomes. To further support people with CKD and at risk of CKD, we also look to achieve sustainable change through health policy reforms. 

We want to provide patients, healthcare providers (HCPs) and decision makers with the necessary information to drive change. As a part of our broader contribution to building knowledge around CKD we continue to generate evidence to help advance clinical practice: DISCOVER-CKD shows a lack of urine albumin-creatinine ratio (UACR) testing, a diagnostic for CKD, and adherence to Kidney Disease Improving Global Outcomes (KDIGO) guidelines; REVEAL-CKD shows the extent of the gaps in early detection of CKD and the clear benefits of diagnosing early; INSIDE-CKD shows the unsustainable future burden of CKD and potential benefits to the healthcare system of improved management; PACE-CKD shows CKD is associated with a poorer quality of life not only for patients but also their carers; and IMPACT CKD provides modelling of the future CKD burden for public health policy planning, including societal and environmental impact.

AstraZeneca in CVRM
Cardiovascular, Renal and Metabolism (CVRM), part of BioPharmaceuticals, forms one of AstraZeneca’s main disease areas and is a key growth driver for the Company. By following the science to understand more clearly the underlying links between the heart, kidneys, liver and pancreas, AstraZeneca is investing in a portfolio of medicines for organ protection by slowing or stopping disease progression, and ultimately paving the way towards regenerative therapies. The Company’s ambition is to improve and save the lives of millions of people, by better understanding the interconnections between CVRM diseases and targeting the mechanisms that drive them, so we can detect, diagnose and treat people earlier and more effectively. 

AstraZeneca
AstraZeneca (LSE/STO/Nasdaq: AZN) is a global, science-led biopharmaceutical company that focuses on the discovery, development, and commercialisation of prescription medicines in Oncology, Rare Diseases, and BioPharmaceuticals, including Cardiovascular, Renal & Metabolism, and Respiratory & Immunology. Based in Cambridge, UK, AstraZeneca’s innovative medicines are sold in more than 125 countries and used by millions of patients worldwide. Please visit astrazeneca.com and follow the Company on social media @AstraZeneca

Contacts
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References

  1. Rao N, et al. Impact of CKD screening in high‑risk populations and guideline-directed therapy on CV event occurrence and costs in Europe: an IMPACT CKD analysis. Presented at: ERA 2024, 23-26 May 2024, Stockholm, Sweden.
  2. Rao N, et al. Impact of CKD screening in high‑risk populations and guideline-directed therapy on RRT, CV events, and mortality in Europe: an IMPACT CKD analysis. Presented at: ERA 2024, 23-26 May 2024, Stockholm, Sweden.
  3. Pecoits Filho R, et al. Kidney-protective medication and risk of adverse clinical outcomes in patients with chronic kidney disease: Preliminary findings from DISCOVER CKD. Presented at: ERA 2024, 23-26 May 2024, Stockholm, Sweden.
  4. PaCE CKD: Examining health status and financial burden in patients with chronic kidney disease: assessing the non-clinical burden of disease. Presented at: ERA 2024, 23-26 May 2024, Stockholm, Sweden.
  5. PaCE CKD: The impact of caregiving on health states and work productivity in chronic kidney disease: results from an international survey. Presented at: ERA 2024, 23-26 May 2024, Stockholm, Sweden.
  6. OECD. "Remuneration of nurses", in Health at a Glance 2023: OECD Indicators. OECD. 2023. https://doi.org/10.1787/f8818f26-en.
  7. Jager KJ, et al. A single number for advocacy and communication-worldwide more than 850 million individuals have kidney diseases. Nephrol Dial Transplant. 2019;34(11):1803-1805.
  8. Bikbov B, et al. Global, regional, and national burden of chronic kidney disease, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet. 2020;395(10225):709-733.
  9. National Kidney Foundation [Internet]. Chronic Kidney Disease (CKD); [cited 2024 March 25]. Available from: https://www.kidney.org/atoz/content/about-chronic-kidney-disease.
  10. Centers for Disease Control and Prevention (CDC) [Internet]. Chronic Kidney Disease: Common - Serious - Costly; [cited 2024 March 25]. Available from: https://www.cdc.gov/kidneydisease/prevention-risk/CKD-common-serious-costly.html.
  11. Centers for Disease Control and Prevention (CDC) [Internet]. Chronic kidney disease in the United States; 2021 [cited 2024 March 25]. Available from: https://www.cdc.gov/kidneydisease/pdf/Chronic-Kidney-Disease-in-the-US-2021-h.pdf.
  12. Briasoulis A, et al. Chronic kidney disease as a coronary artery disease risk equivalent. Curr Cardiol Rep. 2013;15(3):340.

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