Missed Signs of Kidney Disease Impacting Chronic Disease Prevention

According to Michigan Medicine researchers, physicians may be missing early warning signs of kidney disease when examining cerebral palsy patients, failing to promote chronic disease prevention.

Despite using the standard methods of measurement, Daniel Whitney, PhD, lead author of the paper and assistant professor of physical medicine and rehabilitation at Michigan Medicine, explained that missing the early signs of kidney disease could be due to overestimating kidney function.

“The current clinic methods to assess kidney function are influenced by muscle mass in a way that provides an inaccurate picture of kidney health for patients with cerebral palsy,” Whitney said in a press release.

When drawing blood to test for kidney function, physicians will focus on creatinine. The creatinine level is entered into an equation that estimates how well the kidneys are functioning, with a high level of creatinine indicating poor kidney function. However, individuals with cerebral palsy have low muscle mass creating low creatinine levels.

“It’s not an error in the test so much as an error in the interpretation of it,” Whitney said. “Future work will need to identify a better way to capture kidney function given the issues with these clinical tests for people with cerebral palsy.”

Estimated glomerular filtration rate (eGFR) from creatinine is commonly used to understand kidney function and determine the stages of kidney disease. Additionally, it guides recommendations for when patients should be referred for nephrology evaluation.

Researchers worry that if current methods are overestimating kidney function in certain populations, they will not be referred for a nephrology evaluation in time. 

“Physicians also use these estimating equations to guide dosing for some medications, so patients with overestimated kidney function may receive higher doses of medication than they should for their true kidney function,” co-author of the paper and assistant professor of nephrology at Michigan Medicine, Andrea Oliverio, MD, explained.

The research team analyzed data claims from more than 16,700 adults with cerebral palsy, of which 7.3 percent had kidney disease. After accounting for two dozen comorbidities, the team discovered a link between kidney disease and higher mortality in patients.

Researchers also raised concern regarding poor kidney health increasing patients’ risk for cardiovascular disease.

“This helps us see that kidney disease is not some passive, benign condition, but that it’s a problem, and unfortunately, it’s overlooked,” Whitney said. “It’s not like your kidneys hurt when they are low functioning, it’s not that obvious. So, we really have to be more cognizant early on to detect and manage declining kidney function before it causes more medical issues.”

Whitney’s research team is currently examining methods that more accurately measure kidney function for individuals with cerebral palsy. By catching warning signs early, physicians can promote preventive care to delay disease progression.

“We don’t necessarily need to re-invent the wheel when it comes to using standard clinical tests to measure organ health,” Whitney said. “But, for people with cerebral palsy and other disabilities, we need to figure out how to better utilize these tests and their values to capture the individual’s true organ health and function.”