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Yet, the majority remain undiagnosed and untreated.> AtAstraZeneca, we believe we have an important role to play in driving better patient outcomes. We are aiming to help reduce progression to kidney failure by 20% by 2025. Through global collaborative initiatives, informed by our real-world evidence (RWE) programme, our ambition is to support healthcare professionals (HCPs) in prioritising CKD diagnosis and management, ensuring patients understand their risk factors and can address these with their HCPs, and to work with stakeholders in prioritising CKD screening at the policy level. CKD: a silent disease with devastating consequences for patientsIt's staggering to see that although CKD is expected to become the world’s fifth leading cause of mortality by 20404, up to 90% of people living with CKD don't know they have it.> Patients with CKD experience decreased kidney function and if untreated, their CKD could eventually progress to life-threatening kidney failure® although most patients are more likely to die from cardiovascular causes before getting to this stage.° Many of these patients will need renal replacement therapy such as dialysis to replace their kidney function’, which significantly affects their quality of life.® Even before progression, people living with CKD report that their lives and daily activities are impacted by the disease and its complications.® They can experience significant physical limitations, loss of quality of life, unemployment, emotional and cognitive disorders, social isolation and premature death."° If a patient's CKD advances to where they need dialysis, they may experience adcitional sires from the financial impact and time commitment of dialysis, while feeling like a burden to caregivers." CKD does not just impact patients at the individual level, but also society and the environment more broadly. CKD is a leading cause of health expenditure worldwide, and its burden weighs heavily on individuals and healthcare systems alike. In high-income countries across the world, 23% of the annual healthcare budget is ‘spent on renal replacement therapy. "> Additionally, treatments for CKD, like dialysis, leave a considerable carbon footprint and can cause environmental pollution due to frequent medical interventions, the use of products that generate medical waste, energy to run machines and water consumption. '° Dialysis remains one of the most carbon-intensive fields in medicine, consuming enormous amounts of water and producing high amounts of medical waste. '* In a year, globally dialysis uses more than 169 bilion ies of water‘? and creates more than one billion kg of medical waste." As the burden of CKD continues to grow, the environmental impact is expected to do so too: recent UK data predicts environmental impacts equivalent to 1.35 million tonnes of CO2 emissions for patients receiving in- centre haemodialysis by 2032 — and the total environmental impact would likely be larger if all CKD care pathways were included. "© Who is at risk for CKD? CKD can affect anyone, but a person is at an increased risk if they have diabetes, high blood pressure, heart disease, obesity, or a family history of chronic kidney disease.” CKD is known as a silent disease in its early stages, since itis normal for patients to experience few, if any, symptoms early on.'® This means it is often diagnosed late and left untreated for too long.'® Typically, People with CKD could lose up to 90% of their kidney function before experiencing any symptoms of the disease. Lost kidney function cannot be recovered, leaving healthcare providers (HCPs) and patients with the prospect of kidney failure.2° Early CKD diagnosis may slow progression and avoid cardiovascular complications”" Recent RWE of United States health data has demonstrated the benefits of recording a diagnosis at Stage 3 CKD, showing it can help to improve kidney health with a significant decrease in estimated glomerular filtration rate (@GFR) decline, Delaying the diagnosis of Stage 3 by one year resulted in an increased disease progression to Stage 4 or 5 by 40% and the risk of needing a kidney transplant or long-term dialysis treatment by 63%, which are indicators of kidney failure. This highlights the need for earlier screening in at-risk populations 22 While CKD can be difficult to treat on its own, it can also increase the risk of cardiovascular (CV) diseases and death.?*4 Research continues to show the connection between cardiovascular and renal conditions, and since the heart and kidneys are so closely related, CKD can cause or worsen CV conditions such as heartfailure.?°24 Up to one in five patients diagnosed with CKD develop HF, making it the leading CV complication in CKD patients.23:24 Our commitment to people living with CKD We consider ourselves a central part of the healthcare community and are committed to working with the entire kidney community — patients, HCPs, policymakers, industry leaders and more — to transform CKD delivery and care. By 2025, our ambition is to support the screening of 140 million people at risk, and to help transform kidney health and reduce the number of patients developing kidney failure by 20% through partnerships with key healthcare stakeholders and policymakers. To realise this ambition, we launched the Accelerate Change Together (ACT) on CKD programme to drive comprehensive CKD change across the healthcare ecosystem. Through ACT on CKD, we aim to increase awareness of CKD, support primary care physicians to carry out routine screenings and diagnose CKD early, highlight the need for policy reform to achieve sustainable change to support people at risk of CKD, and ultimately reduce the risk of disease progression. Early screening and diagnosis are particularly vital components of ACT on CKD, as early identification and intervention can help improve outcomes and quality of life for CKD patients, Since the launch of ACT on CKD in 2021, we estimate that we have contributed to the screening of over 32 million at-risk people and helped over 10 million CKD patients be diagnosed globally. Projects to encourage urgency of screening and diagnosing CKD early To drive change in CKD, we are working together with global, regional and local partners. We support many projects around the world to help health care professionals facilitate the screening of at-risk patients for CKD by increasing blood (eGFR) and urine (urine albumin-creatinine ratio) testing in the out-patient settings, such as doctor's offices or outpatient clinic waiting rooms. In some countries we also support home screening with easy-to-use urine test kits. At AstraZeneca we are committed to transforming kidney health through partnerships aimed at reducing the number of patients progressing to kidney failure, We hope to help expand early detection to improve patient outcomes and support policy reform to achieve sustainable change in health policies that support people with chronic kidney disease. A growing body of evidence to drive understanding of CKD We want to provide healthcare providers (HCPs), decision makers and patients with the necessary information to drive change. We are committed to expanding understanding around CKD and have generated real-world evidence on:* The extent of underdiagnosis worldwide and the clinical impact of early CKD diagnosis + Description of patient characteristics, monitoring, management, patient disease experience, and quality of life to prospectively test new approaches to CKD management + The projected future prevalence, disease burden, and healthcare use and costs, and the benefits of screening + The projected socioeconomic and environmental impact of CKD and how early diagnosis and intervention can reduce it The prevalence of undiagnosed Stage 3 chronic kidney disease as shown in Reveal CKD requires immediate attention, Results from Inside CKD shows the projected prevalence across major countries and the urgent need for diagnosis at early-stage kidney disease so patients can receive guideline directed medical treatments.2° At AstraZeneca, we are committed to driving meaningful change for patients with chronic kidney disease by highlighting these gaps in diagnosis and helping to provide HCPs with the tools to proactively screen. CKD requires immediate collaborative action We have made it our mission to drive change in chronic kidney disease, which is a growing issue that has an impact in multiple dimensions — including broader society and the environment. Through our extensive ACT on CKD programme, we see an extraordinary opportunity to support health care professionals and clinical practice to help increase diagnosis and early intervention. Itwill take the entire kidney community — patients, HCPs, policymakers, industry members and more — to transform CKD delivery and care to shift from kidney failure to kidney preservation. We remain steadfast in ‘our commitment to transforming CKD and won't rest until we have achieved sustainable change for patients all over the world.You may also like Managing the kidneys and heart holistically Acute and chronic management of cardiovascular conditions Aneglected public health crisis that can be prevented References 1. Jager KJ, et al. A single number for advocacy and communication—worldwide more than 850 million individuals have kidney diseases. Nephrol Dial Transplant. 2019;34(11):1803-1805. 2. Kovesdy CP. Epidemiology of chronic kidney disease: an update 2022. Kidney Int Suppl (2011). 2022 ‘Apr;12(1):7-11. Epub 2022 Mar 18, [cited 2023 Jun 1] Available from: https:/Avww.nebi.nim.nih.gov/pmclarticles/PMC9073222/ 3. Bikbov B, et al. Global, regional, and national burden of chronic kidney disease, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet. 2020;395(10225):709-733. 4. Foreman KJ. et al. Forecasting life expectancy, years of life lost, and all-cause and cause-specific mortality for 250 causes of death: reference and alternative scenarios for 2016-40 for 195 countries and territories. Lancet. 2018; 392(10159):2052-90 5. National Kidney Foundation. Chronic Kidney Disease; 2022 [cited 2023 Jun 1]. 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Vanholder R, et al. Fighting the unbearable lightness of neglecting kidney health: the decade of the Kidney. Clin Kidney J [Internet]. 2021 [cited 2023 Jun 2] ;14(7):1719-30. Available from: https:/Avww.nebi.nim.nih.govipmclarticles/PMC8243275/ 11, American Fund [Internet]. Mental Health and Kidney Disease [cited 2023 June 2] Available from htips:/Avww.kidneyfund orgiliving-kidney-disease/mental-health-and-kidney-disease12, Luyckx V, et al. Sustainable Development Goals relevant to kidney health: an update on progress. Nat Rev Nephrol 17, 15~32 (2021). https://doi.org/10.1038/s41581-020-00363-6 13, Li PK, et al. Tackling Dialysis Burden around the World: A Global Challenge. Kidney Dis (Basel). 2021 May;7(3):167-175. Epub 2021 Apr 29. [cite 2023 Jun 1] Available from: https:/www.nebi.nim.nih.gov/pmc/articles/PMC8215964/#B5 14. Yeo, S.C., et al. Sustainable kidney care delivery and climate change — a call to action. Global Health 18, 75 (2022). [cited 2023 June 2] Available from: https://globalizationandhealth biomedcentral.com/articles/10.1186/s12992-022-00867-9 15. Wieliczko M, et al, Eco-dialysis: fashion or necessity. Int Urol Nephrol, 2020 Mar;52(3):519-523. Epub 2020 Feb 1. [cited 2023 June 2] Available from: https://www.ncbi.nim.nih.gov/pme/articles/PMC7060957/ 16, Garcia Sanchez E and Obolensky K. The growing burden of chronic kidney disease in UK: an IMPACT CKD analysis. Presented at: ERA 2023 Congress; 2023 June 15-18; Milan, Italy. 17. Centers for Disease Control and Prevention. Kidney Disease Basics; 2022 Feb 28 [cited 2023 June 1]. Available from: https://www.cdc.gov/kidneydisease/basics.htm| 18, Bellasi A, et al. Chronic Kidney Disease: The Silent Epidemy. J Clin Med, 2019 Oct 26;8(11):1795. [cited 2023 June 1] Available from: https://www.ncbi.nlm.nih.gov/pme/articles/PMC6912263/ 19, World Kidney Day. [Internet]. Chronic kidney disease. [cited 2023 Jun 1]. Available from: URL: https://www.worldkidneyday.org/facts/chronic-kidney- disease/#:~:text=A%20person%20can%20lose%20up, the %20urine%20and%20foamy%20urine,_ 20. Centers for Disease Control and Prevention (CDC). Live Well With Chronic Kidney Disease; 2021 May 6 {cited 2023 Jun 4]. Available from: URL: https://www.cdc. govikidneydisease/publications-resourcesilive-well- with-chronic-kidney- disease. html#:~:text=While%20it's%20not%20possible%20to improve %20your’20overall%20well%2Dbeing. 21. Shilpak M, et al. The case for early identification and intervention of chronic kidney disease: conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference, [cited 2023 June 1] Available from: https://www.kidney-international.org/article/S0085-2538(20)31210-2/fulltext 22, Tangri N, et al. Patient Management and Clinical Outcomes Associated with a Recorded Diagnosis of Stage 3 Chronic Kidney Disease: The REVEAL-CKD Study. Adv Ther. 2023; 1-2 40:2869-85. 23. House AA et al. Heart failure in chronic kidney disease: Conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference. Kidney Int 2019; 95(6):1304-17. 24, Segall L et al. Heart failure in patients with chronic kidney disease: A systematic integrative review. Biomed Res Int 2014; 2014:937398. 25, Mennini F et al. Inside CKD: projecting the economic burden of chronic kidney disease using patient-level microsimulation modelling. Presented at: ISPOR 2021 Congress; 2021 May 17-20. Available from: https:/Avww.healthlumen.com/wp-content/uploads/2022/06/posb68-inside-ckdispor-eucost- burdenposterrevised-submission-pdf.pdf Veeva ID: Z4-55408 Date of preparation: June 2023 You are now leaving AstraZeneca.com You have selected a link that will take you to a site maintained by a third party who is solely responsible for its contents.AstraZeneca provides this link as a service to website visitors. 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