Study suggests addition of ‘CKD stage 3-plus’ group to care models
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PHILADELPHIA — A study into Medicare beneficiaries with stage 3-5 chronic kidney disease suggests that an additional term should be used to describe a subset of patients with class 3 disease, according to data presented at ASN Kidney Week.
A team from Evergreen Nephrology, a medical service based in Nashville, Tennessee, proposed the term “CKD stage 3-plus” to describe patients with stage 3 CKD and one or more comorbidities that may put them at risk for fast progression, even though their kidney function places them below cutoff points for certain treatments.
“When we look at patients who have CKD 3, generally speaking, most people think those patients are ‘fairly healthy,’ because their kidney function is still fairly preserved in terms of GFR and how they're coded. But in reality, that doesn't tell the full story,” Stanley D. Crittenden, MD, FASN, chief medical officer at Evergreen Nephrology, said.
“If you look at the right CKD 3 patient and you clinically study them ... , they're not just CKD 3, but they're CKD 3 plus multiple comorbidities. These are things like heart failure, vascular disease [or] strokes. Then those patients start to behave and demonstrate clinical characteristics and also financial characteristics just like their CKD 4 or 5 cohorts, who were generally thought of to be [sicker].”
Austin Campbell, PhD, vice president of Strategic Operations at Evergreen Nephrology, noted that the motivation for the study was to denote a specific subset of patients with CKD that could use earlier intervention to provide more effective and less costly treatment moving forward.
“The general recommendation is for nephrologists to begin engagement at stage 4. The fundamental question that guides the study is, ‘Is that always early enough?’ Because it's known that some patients with CKD 3 actually end up progressing very rapidly,” Campbell said.
“And if you could find who those people are going to be and manage their care, then that would be a win for everyone. And so, the case was to figure out, ‘Could we identify a cohort who would benefit from earlier management in a way that would be simple to administer?’”
The retrospective study identified seven comorbidities that were often found in stage 3 CKD and were associated with fast progression. Data from the study showed that about 40% of patients falling into the “stage 3-plus” subset progressed to stage 4 and 5 CKD within a 9-month timeframe.
Crittenden said he hopes that the identification of this specific risk group can help guide clinicians on how to approach patients with both stage 3 CKD and comorbidities and help update certain care models.
“This study demonstrates that we have to be willing to look outside of the box, so to speak, and look at our data more carefully and holistically to actually help us drive those decisions and answers around who needs to be in a care model and who needs to be out of a care model,” he said.
Reference:
- Crittenden, SD et al.TH-PO1003. Presented at: ASN Kidney Week; Nov. 2-5, 2023; Philadelphia.
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