Medical professionals

A first-ever high blood pressure of over 140/90 mmHg, repeatedly measured, or increasingly difficult to control high blood pressure can be an early sign of kidney disease.

According to a 2021 published overview in the Lancet¹, globally 1/3 of all adult men and women have high blood pressure. High blood pressure is silent. Yet, in 2019, nearly half of the people affected worldwide did not know they had high blood pressure, men more frequently than women. And of those who did know about their condition, only 47% of women and 38% of men received treatment. Less than half achieved normal blood pressure with treatment, so overall only 23% of female patients and 18% of male patients were under adequate blood pressure control.

High blood pressure is responsible for 8.5 million known deaths per year, worldwide, due to vascular and kidney diseases.

According to the International Diabetes Federation (IDF) 463 million adults – one in eleven – were living with diabetes in 2019. The number of people living with diabetes is expected to rise to 578 million by 2030. 232 million adults with diabetes remain undiagnosed. The majority have type 2 diabetes. Not treated in time, they risk strokes, blindness, amputation, and heart and/or kidney failure.

Prevention and early detection of type 2 diabetes are therefore of utmost importance.

About one-third of people with type 1 (juvenile onset) diabetes and 4 out of 10 with type 2 (adult onset) diabetes eventually will suffer from kidney disease. In a meta-analysis, a 6-fold higher risk of developing kidney failure requiring kidney replacement therapy was observed in people with diabetes than in those without diabetes.²

In a German study, 89% of individuals with diabetes were diagnosed with CKD stage G2 or higher, but only 2.2% of those with type 1 diabetes and 0.5% with type 2 diabetes had CKD stage G5 or required dialysis.³ Many die during the progression of kidney disease from cardiovascular causes. In fact, the combination of diabetes and CKD is strongly associated with cardiovascular complications and higher morbidity and mortality (KDIGO 2012 clinical practice guideline).

Serum creatinine is the marker to measure kidney function. In kidney disease, due to the decrease of renal filter capacity, waste products such as creatinine and urea accumulate in the blood. Higher levels of these metabolic end products denote poor levels of kidney function. Since creatinine is formed in the muscles, the amount of creatinine in the blood depends on muscle mass and muscle work. The normal value is 0.8 – 1.2 mg/dl or 70 – 106 µmol/l.

The glomerular filtration rate (GFR) can be estimated from serum creatinine using an equation. Similarly, it represents an additional value to assessing kidney function and the severity of the disease. Glomerular filtration is the volume filtered by the glomeruli of the kidneys in a given time. The normal value is 90 to 130 millilitres per minute. Thus, a healthy kidney filters at least 90 millilitres of primary urine from the blood per minute. The GFR is commonly used in everyday clinical practice and the equation takes age and gender into account.
These lab values allow an easy assessment of kidney function.

In addition to blood values, urine values are also important for examining kidney function and damage. If the filtering capacity of the glomeruli is impaired, protein may no longer be retained in the body and passes increasingly into the urine (proteinuria). One component of the proteins is albumin.

To assess kidney damage, the concentration of albumin in the urine should be checked. In a healthy person, it is less than 30 milligrams per day. A rapid urine test – urinalysis or urine dipstick testing – for high albuminuria (30-300 milligrams of albumin) can provide the first indication of kidney damage. However, the albumin concentration in the urine depends on fluid uptake. To increase the accuracy of the test, the albumin concentration should therefore be related to the concentration of creatinine in the urine in a laboratory test (albumin/creatinine ratio). Individuals with diabetes, in particular, should be tested regularly for albumin in the urine to assess kidney damage.

The International Society of Nephrology and KDIGO have released the Toolkit for early Identification of CKD and Intervention. It is aimed at kidney health professionals as well as primary care physicians, and nurses.

Kidney Disease: Improving Global Outcomes is the global organization developing and implementing evidence-based clinical practice guidelines in kidney disease.

KDIGO guidelines focus on topics related to the prevention or management of individuals with kidney diseases. Additional resources are complementing the guidelines such as presentations, explanatory videos and webinars as well as translations of the guidelines.

DGfN, in collaboration with the Association of Senior Hospital Physicians in Nephrology (VLKN) as well as the Association of German Renal Centres (DN), has recently prepared a Guideline aiming at a significant improvement of structural quality as well as quality assurance in the application of intermittent and continuous RRT in hospitals that has been translated into English by ERA and that could become a widely used document to support the best possible quality of care for patients.

This guideline, original version in German, describes the requirements for the personnel, technical and organisational structure for a high-quality and safe implementation of the different modalities of RRT in hospitals. This guideline extends the existing "Dialysis Standard" of the German Society of Nephrology to the sensitive areas of RRT in hospitals.

The SFNDT published an English guide to recommendations for more eco-responsible hemodialysis, prepared by its «Green Nephrology» working group. This "Good Practice Guide for Green Dialysis" proposes a set of actions to reduce the consumption of water, energy, and waste production of dialysis centres but also the share of greenhouse gases from patient travel (3 dialysis sessions per week) and staff.