There are

3 pieces to this puzzle.

Typically, patients only have 1.

Do traditional measures for chronic kidney disease predict disease progression or is another test needed for that?

Traditional chronic kidney disease screening measures, eGFR and UACR, are important as they inform whether chronic kidney disease is present and at what stage. They do not, however, provide sufficient information as to whether a patient is at higher vs lower risk for disease progression. Many patients can remain stable (or even have improvements in eGFR and UACR) over time, thus other inputs are needed to assess future risk.

To gain insights into patient risk for progression, you can order a kidneyintelX.dkd blood test.

Order here.

Why can’t eGFR and UACR, either individually or together, predict chronic kidney disease progression?

Existing measurements don’t adequately and precisely predict disease progression for several reasons.

1. There are issues with albuminuria.
   1. Biological variability
      1. The measurement of albuminuria can be imprecise due to technical factors (time of day) or true normal biological variability. For example, studies indicate that two UACR values in the same patient – just a few weeks apart – vary significantly, such that an increase by 124% or a decrease by 55% from the prior reading can be within the normal range of variability without indicating true clinically significant changes.
   2. Assay variability
      1. The assays for albuminuria are not standardized nationally. Therefore, there can be differences based on the testing platform and clinical lab.
   3. Regression of albuminuria over time.
      1. Some patients will experience spontaneous regression of albuminuria.
   4. Progression without albuminuria.
      1. Data indicates that 20-30% of patients with DKD, who experience progression, never develop albuminuria.
2. There are issues with eGFR.
   1. eGFR is an “estimate.”
      1. Therefore, it may be discordant with true “measured” GFR (mGFR; usually done only in research settings) by > 30% in a significant fraction of patients.
      2. Data indicates that 33-50% of patients have different CKD stages based on eGFR vs. mGFR.
   2. Regression/improvement of eGFR spontaneously.
      1. Data from large database studies indicate that a sizable fraction of patients (roughly equal to the proportion that experience progression) with CKD experience improvement in kidney function over time. While this is contrary to the typical notion that once CKD is present it does not improve, these data points highlight the actual noise and issues with using eGFR as a part of a prediction tool for progression. (See figure below)
3. And then, there’s hyperfiltration.
   1. Hyperfiltration plays a critical role in chronic kidney disease in diabetes as it puts stress on the filtration barrier and post-filtration mechanisms.
   2. The increased flow increases the delivery and reabsorption of small and large molecular weight solutes resulting in injury to the kidneys.
   3. Despite significant damage to some of the kidney’s tissue, the remaining nephrons initially try to compensate, trying to preserve kidney function.

Waikar SS, et al. Am J Kidney Dis. 2018;72(4):538-546. doi:10.1053/j.ajkd.2018.04.023

Liu P et al. JAMA Netw Open. 2021;4(6):e2122828. doi:10.1001/jamanetworkopen.2021.12828.

That’s why, to gain insights into patient risk for progression, you can order a kidneyintelX.dkd blood test.

How is kidneyintelX.dkd different from eGFR and UACR?

The eGFR test and the UACR urine test help to determine whether a patient has chronic kidney disease and at what stage. They do not, however, sufficiently predict a patient’s future kidney health. That is where the kidneyintelX.dkd test can help.

The eGFR + UACR + kidneyintelX.dkd tests all play a critical role in shaping an individual patient’s treatment plan for their kidney disease.

How can kidneyintelX.dkd help in my treatment plan?

1 in 4 of DKD patients are at increased risk for kidney failure and may benefit from more frequent monitoring, lifestyle changes, and treatment interventions. But which ones are they? Our kidneyintelX.dkd test can provide the answer.

To learn about the test, click here.

How does kidneyintelX.dkd work?

To find out how the test works and performs, click here.