Aida Vega, MD, and Fernando Carnavali, MD, discuss the limitations of the tools available to clinicians to screen for DKD, such as Kidney Disease: Improving Global Outcomes (KDIGO).
Aida Vega, MD: Can you go over some of the current guidelines for risk stratification? More importantly, the kidney disease, improving global outcome for KDIGO [kidney disease: improving global outcomes] and the significance of lack of consensus in terms of precision surrounding these guidelines?
Fernando Carnavali, MD: Again, these are well-established tools. And we should emphasize that they do have a role. And the newer tools that we use, and we're talking about KidneyIntelX, but using some of the items, some of the items from the KDIGO into the equation of the new tool. We know that there are limitations and the limitations usually are in the early stages of the disease. Because the components of this, which is the estimated GFR [glomerular filtration rate], and the urinary albumin-creatinine ratio do have variabilities. And there are other factors to consider. And that is the reason that, at the very beginning, they're not as reliable as one will want them to be.
Aida Vega, MD: Yes. And it's unfortunate because, sometimes it doesn't alert us early on and we end up not seeing the patients often where we might have them come back in a year or maybe 6 months and not make any intervention. These factors of the urine albumin and creatinine ratio or the eGFR, those vary a lot by patients. Early in early kidney disease, you have an increased GFR filtration rate, so that sometimes it's hard because of the variability definitely in these parameters of the eGFR and urine albumin-creatinine ratio.
Fernando Carnavali, MD: Including some physiological variability, correct? We have that as well. Yes.
Aida Vega, MD: Can you tell me the role of the kidney failure risk equation risk assessment? That's something that I am not as familiar with and became familiar with it recently more as I've been doing more assessments of progressive kidney disease. We don't use that much at all in primary care. I think that if I mention it to primary care physicians, they wouldn't know it. And can you comment on that, please?
Fernando Carnavali, MD: You're completely correct, Dr Vega. We're not familiarized with it because we're not using it. It is a valuable tool, and we know that. It has limitations, specifically for the people that we are trying to do better with, which is the early stages of failure. And the other thing that we recognize that perhaps because the nature of where this equation was put together, this risk equation was put together, there are some questions about how to apply it to a larger population, like our population. Again, a good tool. And we mentioned before, other tools but with a limitation when we're talking about early stages.
Aida Vega, MD: Exactly. And this risk assessment goes from 1% to 99%. The end is the risk in terms of actually kidney transplant or actual kidney failure. So, for us in primary care, at that point it’s in the hands of the specialists. We're more interested in trying to identify early disease and this one doesn't provide that helpful tool for us.
Transcript edited for clarity