#148 Impact of targeted screening in high-risk individuals and guideline-directed medical therapy on CKD burden in Europe: projections from IMPACT CKD
Bibliographic record
Abstract
Abstract Background and Aims Chronic kidney disease (CKD) is a significant and growing health issue in Europe that remains underdiagnosed and undertreated. This contributes to CKD progression, increased risks of cardiovascular (CV) events, death, and increased need for resource-intensive kidney replacement therapy (KRT; i.e., dialysis and transplantation). While early identification and intervention in high-risk populations, such as those with diabetes mellitus (DM) and hypertension (HTN), have shown cost-effectiveness, the broader impact of screening combined with guideline-directed medical therapy (GDMT) on CKD burden is underexplored. This study examined the impact of targeted screening and improved GDMT adherence on the holistic population level burden of CKD in Europe. Method A European aggregate population comprised of four country populations (Germany, Netherlands, Spain, United Kingdom [UK]) was simulated for 25-years (baseline: 2022; simulated years: 2023–2047) using the validated IMPACT CKD model to compare two scenarios: annual targeted CKD screening for patients with comorbidities (including DM, HTN, heart failure, history of myocardial infarction, and history of stroke), over the age of 45 years combined with 75% adherence to GDMT versus current practice (i.e., underdiagnosis and low treatment rates). Targeted screening involved estimated glomerular filtration rate (eGFR) and urine albumin creatinine ratio tests once per year, and GDMT including kidney-protective treatments (i.e., glucose-lowering, lipid-lowering, antihypertensive medications, and lifestyle changes). The incremental population initiated on GDMT was assumed to experience a multiplicative treatment effect on eGFR decline, CV events, and acute kidney injury events, based on the number of treatments a patient was assigned. Model outcomes of interest for this analysis included cumulative prevalence of CKD and KRT, incidence of CV and mortality events, economic and environmental impacts of CKD and KRT, as well as societal impact over the simulated 25-year period. Results Modelled outcomes of high-risk population screening followed by GDMT versus continuation of current practices for the European aggregate population are shown in Fig. 1 and Table 1. The identification of undiagnosed CKD and improved GDMT was projected to substantially reduce disease progression and need for KRT, with cumulative dialysis numbers (43.8% reduction) and costs (38.0%) dramatically reduced. The environmental impacts of KRT were projected to decrease significantly compared to current practice, with freshwater consumption, fossil fuel use, and carbon emissions decreasing by 40.9%, 38.8%, and 39.2%, respectively. Large cumulative reductions were also predicted for CV events (43.8%) and all-cause mortality (4.6%) compared to current practice. Due to reductions in CKD progression and mortality, a small rise in the number of total CKD patients was projected, with cumulative increases in stage 1–2 by 4.4%, and stage 3–5 by 0.6%. Health costs for the non-KRT CKD population and total costs (including CKD, KRT, and incremental treatment costs) were projected to increase slightly by 1.7% and 3.9%, respectively. Lastly, improvements in projected net workdays, gross domestic product, full-time equivalents, and tax revenue among employed patients and caregivers were projected. Across outcomes, similar trends were observed with a 10-year time horizon but with smaller magnitude. Conclusion We predict significant clinical, socioeconomic, and environmental benefits of implementing targeted screening of populations at high risk for CKD followed by improvements in adherence to guideline-directed interventions across Europe. Compared to current practice over 25 years, implementing this strategy is projected to achieve major reductions in KRT requirement and its health, economic, societal, and environmental burden. Substantial reductions in mortality and CV events will also be achieved. These results highlight the importance of early action on CKD to lessen its future burden.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".