Rapidly developing kidney disease in diabetics may be predictable with new precision medicine test
High-quality, cost-effective strategies for kidney care have been a focus of healthcare leaders for many years. More than 34 million Americans live with diabetes and may be affected at some point by diabetic kidney disease and kidney decline.
While kidney disease progresses slowly in many individuals with diabetes, rapid kidney decline also occurs. Rapid kidney decline is unpredictable and leads to poor outcomes; therefore, scientists are looking for a better way to proactively test and predict when rapid kidney decline will occur.
Current clinical testing for rapidly developing kidney disease involves measuring a patient’s glomerular filtration rate (GFR) and urine albumin excretion (UAE). These measures indicate how well the kidneys are working. Glomerular filtration rate estimates how much blood is passing through the kidneys. Urine albumin excretion measures the amount of albumin in urine.
The problem with current clinical testing is that neither the glomerular filtration rate nor the urine albumin excretion are good at predicting future kidney function. These tests are limited to identifying rapid kidney decline when it is already in progress. The tests are also used for both Type 1 and Type 2 diabetes, even though each type has different biological causes.
However, research out of the University of Michigan Health System takes a new, personalized approach to evaluating the risk of rapid kidney decline in diabetic patients. Published in July 2021, a study detailed in Diabetes Care explains that at-risk rapid kidney decline in Type 1 diabetic patients can be predicted before there is a change in kidney function.
New Lipid Panel Test May Predict At-Risk Rapid Kidney Decline When GFR and UAE Are Normal
“What we’ve discovered suggests there’s a panel of lipids that can predict rapid decline of kidney function at such an early stage of type 1 diabetic kidney disease when both the glomerular filtration rate and the urine albumin-creatinine ratio are normal,” said Farsad Afshinnia, MD, the study’s lead author, in a recent news release.
Afshinnia’s team tested 800 patients with type 1 diabetes over a four-year period and studied over 300 different types of lipids, or fatty acid molecules. The researchers found that 47 of these lipids were significantly different in patients who ended up having a rapid decline in their kidney function, allowing researchers to provide targets that could be tested for predicting this rapid decline in future diabetic patients.
Not only does this discovery predict kidney outcomes for patients with type 1 diabetes, but it may even suggest why this rapid decline occurs. “These findings not only provide a platform for risk stratification, but also suggest the underlying mechanism of progressive kidney disease,” said Afshinnia. “Understanding the mechanism may be a future target for therapeutic intervention.”
The research team intends to continue their groundbreaking work to see if therapeutics targeting two of the most affected lipids can reduce future kidney damage in these patients. “This panel of lipids is unique only for type 1 diabetic kidney disease,” said Subramaniam Pennathur, MD, a member of the research team. “That suggests a unique type 1 diabetic kidney disease specific risk-marker panel. We may be able to manipulate phospholipase A1 and A2 in future studies to see if it’s a potential target for preventing the progression of diabetic kidney disease at its early stages.”
Kidney-Care Programs Test Early Intervention in Kidney Outcomes
As hospital leaders know, kidney care strategies and outcomes are being tested beyond the laboratories of academic medical centers.
In early December, CVS Health Corp. reported some success in caring for patients with kidney disease as a potential template for CVS’s expansion into care for other chronic conditions, reported Bloomberg. CVS Health Corp. in 2019 created dozens of algorithms it says can predict which patients could develop kidney disease, and when.
Meanwhile, another effort brought together the work of in vitro diagnostic platform and machine learning algorithm Renalytix AI, and dialysis provider DaVita in 2021. This program pursues risk-sharing arrangements with healthcare providers and payers, reported Fierce Healthcare in January. DaVita Integrated Kidney Care currently manages more than 30,000 patients under value-based care arrangements with commercial payers and through government programs, according to a recent news release.
“Making fundamental change in kidney disease health economics and outcomes must begin with providing a clear, actionable understanding of disease progression risk,” said Renalytix AI Chief Executive Officer James McCullough, as part of the company’s announcement in early 2021.
It may be helpful to know that a health plan with 200,000 commercial members may spend some $16 million annually on kidney disease; the annual medical expense for a single end-stage renal disease (ESRD) patient estimated at $260,000 for an average of nearly three years. With spikes in inpatient admissions, readmissions, emergency room and specialist visits, there is large variability in claims, states a 2018 report from Optum.
New kidney care models and the possibility of payment adjustments for certain claims will continue to challenge traditional approaches. What is learned from these developments and more will influence a new standard of care for people at risk for compromised kidney function.
Almost every hospital in the United States provides treatment to patients with diabetes. With research emerging from University of Michigan Health System and elsewhere, hospital leaders can anticipate a range of precision medicine-based resources to consider as part of their specialized kidney care programs.
—Caleb Williams
Related Information:
Precision medicine helps identify “at-risk rapid decliners” in early-stage kidney disease
CVS Plans to Tackle More Diseases After Kidney Care Success
DaVita, RenalytixAI partner to collaborate on kidney care program
Kidney Care Choices (KCC) Model’s First Performance Year Start Date January 1, 2022
How specialized kidney care programs yield cost savings and better outcomes