Chronic kidney disease: research and references
Key research and evidence relating to chronic kidney disease (CKD) and clinical practice.
Reports related to CKD
| Reference | Summary | |
|---|---|---|
| Make the Link: Kidneys, diabetes and heart | This is an evidence report released by Kidney Health Australia in 2021. The report highlights the high burden of CKD in Australia, the interrelationships between CKD, diabetes and cardiovascular disease in the Australian population and the impact of these conditions on mental health, cognitive and economic outcomes. | |
| Catching Some Air – Asserting Aboriginal and Torres Strait Islander information rights in renal disease: the final report | This report was developed by the Menzies School of Health Research 2019 for the Catching Some Air project, which aimed to produce an informed set of guidelines for the management of CKD in Aboriginal and Torres Strait Islander people, through an Aboriginal and Torres Strait Islander- led, culturally appropriate consultation process. | |
| Pharmaceutical Society of Australia (PSA) – Medicine Safety: Take Care | This report presents statistics about the number of Australians who present to emergency departments or are hospitalised each year, as a result of medicine errors, inappropriate use, misadventure and interactions. A key finding was that almost 1 in 4 older people in the community are prescribed excessive doses of medicines cleared by the kidneys. | |
Australian Bureau of Statistics Australian Health Survey: Biomedical Results for Chronic Diseases, 2011-2012 | The publication includes information from the National Health Measures Survey (NHMS), the biomedical component of the 2011-2013 Australian Health Survey (AHS). It presents test results for CKD, including prevalence rates for kidney function, cardiovascular disease and diabetes. | |
| Australian Bureau of Statistics Chronic Kidney Disease Web report | This web report has developed core monitoring information on the prevalence, incidence, hospitalisation and deaths from CKD in Australia (updated 15 July 2020). |
Resources to guide dose adjustment in CKD
| Reference | Summary |
|---|---|
The Renal Drug Reference Guide | This resource is an essential tool for health professionals managing patients with kidney disease and transplantation. |
NSW Health: Hunter New England Local Health District: | This fact sheet provides guidance on assessing glomerular filtration rate (GFR) for adjusting dosage of medicines significantly cleared by the kidneys. |
| Australian Medicines Handbook https://amhonline.amh.net.au/auth | The handbook provides dose recommendations for medicines cleared by the kidneys. |
The Royal Australian College of General Practitioners (RACGP) | This clinical resource focuses on providing appropriate care for older people. Links to several tools are included. Part A. Deprescribing This section provides guidance on:
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Primary Health Network Tasmania | These resources provide guidelines for specific medicines with summaries of factors favouring discontinuation and deprescribing. |
The Medical Journal of Australia (MJA) | Appendix 1 from the Australian Diabetes Society Position Statement provides a list of medicine treatment options for people with diabetes and CKD. |
Hedayati et al. 2012 | A practical approach to the treatment of depression in patients with CKD and end-stage renal disease. Table 2 includes a list of common classes of antidepressant medications with suggested dosing in CKD, and potential adverse effects. |
Non-pharmacological protective strategies for management of CKD and related comorbidities
| Reference | Summary |
|---|---|
National Health and Medical Research Council (NHMRC) | Generalised, evidence-based information about healthy food choices. |
Kidney Health Australia Kidney Health Australia handbook Chronic Kidney Disease Management in Primary Care 4th edition (pages 36-38) | Information to discuss with your patients to slow the progression of kidney disease: Living well with kidney disease Recommendations for lifestyle modification and nutrition |
| Shipak et al. 2022 Effect of structured, moderate exercise on kidney function decline in sedentary older adults | This ancillary analysis of a randomised clinical trial showed that when compared with health education, a physical activity and exercise intervention slowed the rate of decline in eGFR among sedentary older adults living in the community. |
Pharmacological protective treatments for management of CKD and related comorbidities
| Reference | Summary | |
|---|---|---|
General Levy et al. 2011 | This is a summary of the KDIGO collaborative meta-analysis examining the relationship of estimated glomerular filtration rate (eGFR) and albuminuria to mortality and kidney outcomes. Reducing albuminuria through use of an angiotensin converting enzyme (ACE) inhibitor has been shown to slow progression to kidney failure and reduce cardiovascular mortality. | |
| Therapeutic Guidelines: Diabetic Kidney Disease | These guidelines provide recommendations to reduce the risk of progression of diabetic kidney disease including pharmacological treatments to optimise glycaemic profile and blood pressure. | |
ACEi Zhang et al. 2020 | A network meta-analysis assessing the advantages of ACE inhibitors or angiotensin II receptor blockers (ARBs) in reducing cardiovascular events and delaying kidney failure in patients with CKD. It found ACE inhibitors to be superior to ARBs and other antihypertensive medicines and had the highest benefits for the prevention of kidney events, cardiovascular outcomes, cardiovascular death and all-cause mortality in non-dialysis patients with Stage 3-5 CKD. | |
SGLT-2i Toyama et al. 2019 | A systemic review and meta-analysis assessing the efficacy and safety of SGLT2 inhibitors in patients with type 2 diabetes and CKD. It found that SGLT2 inhibitors reduce the risk of cardiovascular and renal outcomes in these patients, without additional safety concerns. | |
Heerspink et al. 2020 | This randomised, double-blinded, placebo-controlled trial investigated the effect of dapagliflozin in 4304 patients with CKD. The authors concluded that the risk of a composite of a sustained decline in the eGFR of at least 50%, kidney failure, or death from renal or cardiovascular causes was significantly reduced compared with placebo for patients with CKD, with or without diabetes. | |
| Australian Government Department of Health Therapeutic Goods Administration Australian Public Assessment report for dapagliflozin, March 2022 | Dapagliflozin is TGA indicated to reduce the risk of progressive decline in kidney function in adults with proteinuric CKD (Stage 2, 3 or 4 and urine albumin-creatinine ratio ≥ 30 mg/g). | |
GLP-1 RA Greco et al. 2019 | This review focuses on the actions of GLP-1 receptor agonists on glucose metabolism and kidney physiology and evaluates direct and indirect mechanisms through which these medicines may provide renal protection for patients with type 2 diabetes. | |
Mann et al. 2017 | GLP-1 receptor agonists may exert beneficial effects on traditional risk factors for CKD, for example through lowering glucose and blood pressure (BP), decreasing insulin levels, and causing weight loss. GLP-1 receptor agonists demonstrated induce natriuresis and diuresis which may explain their BP- lowering effects. The renal benefit for patients with type 2 diabetes demonstrated in the LEADER trial with liraglutide, was primarily driven by a 26% reduction in macroalbuminuria. | |
| Australian Government Department of Health Therapeutic Goods Administration Australian Public Assessment report for liraglutide April 2019 | In patients where liraglutide is indicated to improve glycaemic control, liraglutide is indicated to reduce the risk of cardiovascular events in those at high cardiovascular risk, as an adjunct to standard-of-care therapy. Not recommended for patients with kidney failure. | |
Marso et al. 2016 Semaglutide and cardiovascular outcomes in patients with type 2 diabetes | The SUSTAIN-6 trial showed a 46% reduction in macroalbuminuria seems to be exclusively responsible for the better renal outcome of semaglutide in patients with type 2 diabetes. | |
| Australian Government Department of Health Goods Administration Australian Public Assessment report for semaglutide October 2020. | Semaglutide is indicated for the treatment of adults with insufficiently controlled type 2 diabetes mellitus as an adjunct to diet and exercise:
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