High Prevalence of Undiagnosed Kidney Disease in Those Presenting with Troponin Positive Acute Coronary Syndrome

Abstract

Aim: The aim of this study is to assess the prevalence and knowledge of chronic kidney disease (CKD) in those presenting to a District General Hospital (DGH) in the United Kingdom with troponin positive acute coronary syndrome (ACS) as compared to a sample of the general population. Methods: A retrospective observational study. Data were collected from ProForma completed during the 18-month period from 1 November 2007 to 30 April 2009. The stage of CKD and the proportion of undocumented CKD at presentation were calculated and the mean stage was compared with the general practice population (of similar demographics) sampled by de Lusignan et al. (Identifying patients with chronic kidney disease from general practice computer records. Fam Pract. 2005;22:234–241.) using the t-test statistics. Results: A total of 936 patients (600 men and 336 women) presented with troponin positive ACS; their mean stage of CKD = 2.874 ± 0.024. This was significantly different from the mean stage of CKD = 1.999 ± 0.004 found within the general population (p < 0.001). About 58.6% of patients with CKD stages 4 or 5 had no knowledge or documentation of their renal impairment. Conclusions: Among those presenting to hospital with troponin positive ACS were many patients with undocumented severe renal impairment, emphasizing the need for general practitioners to screen for renal disease and refer to specialist nephrology services where appropriate. Joint renal and cardiac clinics may offer better care for this group of patients’ long-term care.