DIAGNOSIS OF CHRONIC KIDNEY DISEASE IN PRIMARY CARE: PP.30.179

Abstract

Objective: 20% of patients attended in primary care setting have chronic kidney disease (CKD) defined as a glomerular filtration rate (GFR) less than 60 ml/min per 1.73 m2. The prevalence of CKD was studied and its association with at-risk populations. Design and Method: A cross-sectional study involving 4 primary care centres. We randomly selected adult patients that were attended from 1/06/09 to 31/08/09 and had defined CKD or at least one of the following risk factors for CKD: age >60 years, hypertension, diabetes or cardiovascular disease. We estimated GFR in those whose serum creatinine had been registered in the last year, using MDRD-4 formula. We also examined other multivariable associations. Results: 405 patients studied. 108 patients (26.6%) had CKD after calculating GFR. Only 10.2% of the latter had their GFR registered previously, in their medical records. However, 94.4% of them had serum creatinine registered. 66.7% of patients with CKD had levels of serum creatinine <1.2 mg/dl (occult kidney disease). The following differences were observed between patients with or without CKD through regression analysis, respectively: hypertension, 77.8% to 62% (p = 0.007); diabetes, 27.8% to 17.7% (p = 0.079); cardiovascular disease, 19.4% to 16.9% (p = 0.609); mean age, 73.64 to 69.47 (p = 0.218). 81.5% of patients with CKD had a body mass index > 25 kg/m2 whereas 73.3% without CKD (non-significant difference). In both groups, levels of LDL-cholesterol > 130 mg/dl were about 45–50%. There were no differences in blood pressure control. 29.6% of patients with CKD had been prescribed non-steroidal anti-inflammatories compared to 27.3% without CKD (non-significant difference) during the last year. Conclusions: Only 5.2% of the 405 patients had their GFR estimation registered. A strong statistical association between hypertension and CKD was observed. CKD patients were older and had diabetes and cardiovascular disease in higher proportions. We concluded that usage of MDRD-4 should be applied to patients at risk of CKD, particularly for hypertension and diabetes evaluation.