Abstract
BackgroundChronic kidney disease (CKD) is a common comorbid condition in coronary heart disease (CHD). CKD predisposes the patient to acute kidney injury (AKI) during hospitalization. Data on awareness of kidney dysfunction among CHD patients and their treating physicians are lacking. In the current cross-sectional analysis of the German EUROASPIRE IV sample we aimed to investigate the physician’s awareness of kidney disease of patients hospitalized for CHD and also the patient’s awareness of CKD in a study visit following hospital discharge.MethodsAll serum creatinine (SCr) values measured during the hospital stay were used to describe impaired kidney function (eGFRCKD-EPI < 60 ml/min/1.73m2) at admission, discharge and episodes of AKI (KDIGO definition). Information extracted from hospital discharge letters and correct ICD coding for kidney disease was studied as a surrogate of physician’s awareness of kidney disease. All patients were interrogated 0.5 to 3 years after hospital discharge, whether they had ever been told about kidney disease by a physician.ResultsOf the 536 patients, 32% had evidence for acute or chronic kidney disease during the index hospital stay. Either condition was mentioned in the discharge letter in 22%, and 72% were correctly coded according to ICD-10. At the study visit in the outpatient setting 35% had impaired kidney function. Of 158 patients with kidney disease, 54 (34%) were aware of CKD. Determinants of patient’s awareness were severity of CKD (OReGFR 0.94; 95%CI 0.92–0.96), obesity (OR 1.97; 1.07–3.64), history of heart failure (OR 1.99; 1.00–3.97), and mentioning of kidney disease in the index event’s hospital discharge letter (OR 5.51; 2.35–12.9).ConclusionsAlthough CKD is frequent in CHD, only one third of patients is aware of this condition. Patient’s awareness was associated with kidney disease being mentioned in the hospital discharge letter. Future studies should examine how raising physician’s awareness for kidney dysfunction may improve patient’s awareness of CKD.
Highlights
Chronic kidney disease (CKD) is a common comorbid condition in coronary heart disease (CHD)
We describe the level of CKD awareness in CHD patients in the ambulatory setting following hospital discharge
Determinants of patients’ awareness of CKD and the fact that CKD or acute kidney injury (AKI) were mentioned in the hospital discharge letter in all participants were investigated by univariable and multivariable logistic regression, using backwards selection including variables statistically significant in univariate analysis
Summary
Chronic kidney disease (CKD) is a common comorbid condition in coronary heart disease (CHD). CKD predisposes the patient to acute kidney injury (AKI) during hospitalization. Chronic kidney disease (CKD) has been identified as a common and important risk factor in patients with coronary heart disease (CHD) [1,2,3,4]. Patients with CKD represent a multi-morbid population [5] which is at risk for various complications, e.g. episodes of acute kidney injury (AKI), in hospital stays of various causes, including CHD [6]. The health economic relevance of kidney disease, acknowledging multi-morbidity of patients and risk for complications, is reflected by the fact that adequate ICD-10 coding for CKD and AKI impacts on reimbursement [11]. It is suggested that well-informed patients aware of their disease may show better adherence to medication and may easier achieve treatment targets [16, 17]
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