World Kidney Day: A Bayer Survey Reveals Physicians Agree on Need for Earlier Testing and Increased Transparent Communication for People Diagnosed With Chronic Kidney Disease Associated With Type 2 Diabetes

Today, World Kidney Day, results from a survey designed to gain a broader understanding of the attitudes and challenges faced by healthcare professionals (HCPs) in diagnosing, managing and treating people with chronic kidney disease (CKD) associated with type 2 diabetes (T2D) were announced. The survey was executed by Bayer and fielded in partnership with MedSurvey, a leading medical market research company.

Findings from the survey, which queried a total of 1,000 respondents made up of nephrologists, primary care physicians (PCPs), nurse practitioners (NPs) and physician assistants (PAs), revealed that HCPs believe care can be improved, with a collective acknowledgement that people with T2D need to be tested for CKD earlier and more often, despite results showing that guideline-driven tests to monitor for CKD and its progression, like urine albumin-creatinine ratio (uACR), a urine test to assess kidney function, are underutilized.^1,2

When people are diagnosed with CKD associated with T2D, they often receive initial care from their PCP and are referred to a nephrologist (kidney specialists), only after their CKD has progressed.³

Survey results also revealed that PCPs and nephrologists have differing opinions on who should be the lead medical professional coordinating treatment and management, resulting in a significant number of patients not being referred to nephrologists earlier, despite the majority of HCPs surveyed agreeing that nephrologists need to be brought in sooner.¹

"Research has shown that co-management between a primary care physician and a nephrologist is associated with improved quality of care, delayed dialysis and more frequent testing, but we wanted to more deeply understand some of the challenges the treatment team faced in an effort to incite conversations about how we can improve on them," said German Guerrero, M.D., Executive Medical Director, Cardiorenal, Bayer.⁴ "At Bayer, we are working to ensure people with chronic kidney disease associated with type 2 diabetes receive optimal care that ultimately leads to earlier diagnosis and treatment and better outcomes."

Additional Findings Include:

HCPs Agree on Need for Better Communication and Earlier Testing

• More than four in five HCPs (84%) agree people are often unprepared for their diagnosis¹
  • The majority of HCPs (88%) agree they need to use clearer and more transparent language when talking about the risk of CKD with people diagnosed with T2D¹
  • Nearly nine in 10 HCPs (89%) agree that people diagnosed with T2D don't understand their increased cardiovascular risk once they are diagnosed with CKD¹
• The majority of HCPs surveyed (80% PCPs, 88% nephrologists, 88% NPs/PAs) agree the medical community could do better and diagnose CKD in people with T2D earlier¹
  • While a majority of HCPs are using estimated glomerular filtration rate (eGFR) blood tests to assess kidney function at least once every few months (62% PCPs, 80% nephrologists, 77% NPs/PAs), uACR tests are significantly underutilized (30% PCPs, 57% nephrologists, 38% NPs/PAs), clashing with guideline recommendations to test more frequently¹

Differing Viewpoints on Co-Managing People With CKD Associated With T2D

• Nephrologists believe they should be the lead HCP in both diagnosing and managing CKD in T2D patients (58% and 90%, respectively), while PCPs see this as their role (88% and 56%, respectively)¹
• The vast majority of HCPs (77% PCPs, 90% nephrologists, 89% NPs/PAs) agree nephrologists need to be brought in earlier, yet 88% of PCPs may choose not to refer people with CKD to a nephrologist; the top reasons include¹:
  • Two-thirds (59%) believe they can manage CKD themselves
  • Almost half (45%) feel the patient doesn't want to see a nephrologist
  • More than a third (34%) don't feel their patients' symptoms require a nephrologist
• Over eight in 10 nephrologists wish they were brought in earlier to diagnose and manage CKD (82% and 89%, respectively), with three-quarters (76%) reporting that PCPs may often underestimate the risks and severity of CKD¹
• The top challenges HCPs face when co-managing patients include¹:
  • Patients often become confused about who to go to for what (77%)
  • Lack of timely/centralized communication (64%)
  • Limited access to the other HCP (58%)
  • Unclear roles and responsibilities between HCPs (58%)

"These findings reinforce the importance of our commitment to identifying resources and programs aimed at better understanding the real-world management of chronic kidney disease and expanding screening and early care management," said Dr. Guerrero. "Together?with healthcare professionals and the broader kidney community?we have an opportunity to improve the diagnosis and management of chronic kidney disease to truly advance care."

About the Survey
MedSurvey conducted a 15-minute online survey between January 20 and February 16, 2023. The survey included 1,000 U.S. HCPs, including nephrologists (n=200), family medicine/general practice/primary care internal medicine (n=500) and nurse practitioners or physician assistants (n=300), who are duly licensed in the state where they practice and are currently treating people diagnosed with CKD associated with T2D. The survey asked HCPs about their current collaborative care practices and looked to identify barriers and disparities in these practices to improve the treatment of CKD associated with T2D and its associated conditions. The online survey is not based on a probability sample and therefore no estimate of theoretical sampling error can be calculated.

About Chronic Kidney Disease Associated With Type 2 Diabetes
People with CKD associated with T2D are three times more likely to die from a CV-related cause than those with T2D alone.⁵ CKD is a serious and progressive condition that is generally underrecognized.⁶ CKD is a frequent complication arising from T2D and is also an independent risk factor of CV disease.^7-9 Approximately 40% of all people with T2D develop CKD.⁹ Despite guideline-directed therapies, people with CKD associated with T2D remain at high risk of CKD progression and CV events.^7,8,10,11 T2D is the leading cause of end-stage kidney disease, which requires dialysis or a kidney transplant to stay alive.^12-14

About Bayer's Commitment in Cardiovascular and Kidney Diseases
A leader in the cardiovascular (CV) space, Bayer upholds a long-standing commitment to delivering science for a better life by advancing the treatment landscape.

Bayer's cardiorenal franchise, which began with the discovery and development of a number of therapies, now includes a number of products and compounds in various stages of preclinical and clinical development with the potential to impact the way that cardiovascular and kidney diseases are treated.

Bayer is focused on advancing new treatment approaches for areas of high unmet medical need in CV and kidney diseases by identifying resources and programs aimed at better understanding the real-world management of CKD, expanding screening and early care management for CKD, aligning with and supporting groups and institutions that share the common goals of improving health outcomes, promoting health literacy and education and promoting research and initiatives that represent the diversity required to address the needs of all patients.

About Bayer
Bayer is a global enterprise with core competencies in the life science fields of health care and nutrition. Its products and services are designed to help people and the planet thrive by supporting efforts to master the major challenges presented by a growing and aging global population. Bayer is committed to drive sustainable development and generate a positive impact with its businesses. At the same time, the Group aims to increase its earning power and create value through innovation and growth. The Bayer brand stands for trust, reliability and quality throughout the world. In fiscal 2021, the Group employed around 100,000 people and had sales of 44.1 billion euros. R&D expenses before special items amounted to 5.3 billion euros. For more information, go to www.bayer.com.

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Forward-Looking Statements
This release may contain forward-looking statements based on current assumptions and forecasts made by Bayer management. Various known and unknown risks, uncertainties and other factors could lead to material differences between the actual future results, financial situation, development or performance of the company and the estimates given here. These factors include those discussed in Bayer's public reports which are available on the Bayer website at www.bayer.com. The company assumes no liability whatsoever to update these forward-looking statements or to conform them to future events or developments.

References:

1. Bayer survey conducted by MedSurvey; January 20-February 16, 2023.
2. Alfego D, et al. Chronic kidney disease testing among at-risk adults in the U.S. remains low: real-world evidence from a national laboratory database. Diabetes Care. doi:10.2337/dc21-0723
3. Dharod A, et al. Primary care referrals to nephrology in patients with advanced kidney disease. Am J Manag Care. 2020;26(11):468-474. doi:10.37765/ajmc.2020.88526
4. Skolnik NS, Style AJ. Importance of early screening and diagnosis of chronic kidney disease in patients with type 2 diabetes. Diabetes Ther. 2021;12(6):1613-1630. doi:10.1007/s13300-021-01050-w
5. Afkarian M, et al. Kidney disease and increased mortality risk in type 2 diabetes. J Am Soc Nephrol. 2013;24(2):302-308.
6. Breyer MD, et al. Developing treatments for chronic kidney disease in the 21st century. Semin Nephrol. 2016;36(6):436-447.
7. Anders HJ, et al. CKD in diabetes: diabetic kidney disease versus nondiabetic kidney disease. Nat Rev Nephrol. 2018;14:361-377.
8. Thomas MC, et al. Diabetic kidney disease. Nat Rev Dis Primers. 2015;1:1-20.
9. Bailey R, et al. Chronic kidney disease in US adults with type 2 diabetes: an updated national estimate of prevalence based on Kidney Disease: Improving Global Outcomes (KDIGO) staging. BMC Res Notes. 2014;7(1):415. doi:10.1186/1756-0500-7-415
10. KDIGO 2012 clinical practice guideline for the evaluation and management of chronic kidney disease. Kidney Int. 2013;3:1-150. https://kdigo.org/guidelines/ckd-evaluation-and-management/
11. American Diabetes Association. Standards of medical care in diabetes?2021. Diabetes Care. 2021;44(1):1-244.
12. National Diabetes Statistics Report 2020: Estimates of Diabetes and Its Burden in the United States. Centers for Disease Control and Prevention. Accessed July 9, 2021. https://www.cdc.gov/diabetes/pdfs/data/statistics/national-diabetes-statistics-report.pdf
13. Stages of CKD. American Kidney Fund. Accessed May 11, 2021. https://www.kidneyfund.org/kidney-disease/chronic-kidney-disease-ckd/stages-of-chronic-kidney-disease/
14. United States Renal Data System. USRDS Annual Data Report. National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases; 2020. Accessed November 2021. https://adr.usrds.org/2020/chronic-kidney-disease/6-healthcare-expenditures-for-persons-with-ckd