Undiagnosed Chronic Kidney Disease in a Child With Fractures Presenting to a Pediatric Orthopedic Clinic.

The objective of this study was to use cross-sectional, nationally representative data to examine the relationship between self-reported hearing impairment and undetected diabetes, hypertension, hypercholesterolemia, and chronic kidney disease. We analyzed the National Health and Nutrition Examination Survey for the years 2007-2012 for individuals 40 years of age and older without previously diagnosed cardiovascular disease. Analyses were conducted examining hearing impairment and undiagnosed disease. The unweighted sample size was 9,786, representing 123,444,066 Americans. Hearing impairment was reported in 10.2% of the individuals. In unadjusted analyses, there was no significant difference between adults with hearing impairment and adults with typical hearing for undiagnosed diabetes, hypertension, or hypercholesterolemia. A higher proportion of adults with hearing impairment than adults with typical hearing had undiagnosed chronic kidney disease (20.1% vs. 10.7%; p = .0001). In models adjusting for demographics and health care utilization, hearing impairment was associated with a higher likelihood of having undiagnosed chronic kidney disease (odds ratio = 1.53, 95% CI [1.23, 1.91]). Individuals with hearing impairment are more likely to have undiagnosed chronic kidney disease. Hearing impairment may affect disclosure of important signs and symptoms as well as the comprehension of medical conversations for chronic disease management. General practitioners can play a critical role in improving medical communication by responding with sensitivity to the signs of hearing impairment in their patients.

BackgroundThe effectiveness of identifying and monitoring early-stage chronic kidney disease (CKD) is not fully recognised. This study quantified people with undiagnosed CKD among the middle-aged Japanese population and clarified potential...

Chronic kidney disease (CKD) remains underdiagnosed in people with type 2 diabetes mellitus (T2DM), particularly in early stages, despite its strong association with renal disease progression, cardiovascular outcomes, and current guideline recommendations for early cardio-renal protective interventions. Contemporary, nationally representative primary care data from Spain evaluating CKD underdiagnosis in people with T2DM are limited. This study estimated the prevalence of diagnosed and undiagnosed CKD in adults with T2DM in Spain, described treatment patterns by CKD diagnosis status, and identified factors associated with undiagnosed CKD. A planned secondary analysis of the DIAMOND2 multicentre cross-sectional study was performed in Spanish primary care. Data were retrospectively collected from electronic medical records during the calendar year 2022, and the analysis was performed between January and July 2023. Data from 5009 adults with T2DM randomly selected from 70 centres were analysed. CKD was defined according to KDIGO 2024 criteria as estimated glomerular filtration rate (eGFR) < 60 mL/min/1.73 m² and/or urine albumin-to-creatinine ratio (uACR) ≥ 30 mg/g. Patients were classified as having diagnosed CKD (recorded), undiagnosed CKD (meeting criteria without record), or no CKD. Descriptive statistics were used, and multivariable Poisson regression models with robust variance were fitted to identify factors associated with undiagnosed CKD. True CKD prevalence was 32.0 %, with 54 % undiagnosed. Undiagnosed CKD was mainly in patients with isolated eGFR or uACR abnormalities and lower KDIGO risk. SGLT2 inhibitors were prescribed to 45.2 % of diagnosed and 40.0 % of undiagnosed CKD, versus 35.4 % without CKD (p < 0.001). In multivariable analysis, undiagnosed CKD was associated with metformin use and higher eGFR, and inversely with diabetes duration, heart failure, and proliferative retinopathy. Over half of CKD cases in Spanish adults with T2DM remain undiagnosed, particularly at early disease stages, limiting risk stratification and optimal cardio-renal management. These findings underscore the need for systematic CKD screening and improved recognition of early kidney disease in primary care.

Background and Aims Chronic kidney disease (CKD), affecting 6–10% of adults, often progresses silently until advanced stages, resulting in frequent underdiagnosis and inadequate management. To compare diagnosed, proxy-diagnosed, and undiagnosed CKD patients in terms of prevalence, assessment, nephroprotective treatment, healthcare utilization, and mortality. Method A retrospective observational study using Region Halland's healthcare data included adults meeting the confirmed CKD criteria defined by Kidney Disease: Improving Global Outcomes (KDIGO) from January–December 2019. Participants were classified into three groups: ICD-coded CKD (diagnosed CKD), CKD-related diagnoses (proxy-diagnosed CKD), and those meeting CKD criteria without an ICD diagnosis (undiagnosed CKD). Results Among 20488 CKD patients, 21% had an ICD-documented diagnosed CKD, 18% had a proxy-diagnosed CKD, and 61% were undiagnosed CKD. The mean ages were 76.4 years for diagnosed CKD, 62.4 years for proxy-diagnosed CKD, and 81.8 years for undiagnosed CKD (P &amp;lt; 0.001). Blood pressure follow-up rates were 88% for diagnosed, 67% for proxy-diagnosed, and 80% for undiagnosed, while glucose testing rates were 83%, 69%, and 76%, respectively. eGFR testing rates were 73%, 53%, and 66%. Urine albumin-creatinine ratio (UACR) testing rates were 25% in the overall population, 45% among individuals with diagnosed CKD, and 19% in both the undiagnosed CKD and proxy-diagnosed CKD groups. Renin-angiotensin system inhibitors were used in 45% of the cohort: 51% in diagnosed CKD, 28% in proxy-diagnosed CKD, and 47% in undiagnosed CKD. The relative risk of hospitalization, adjusted for age and comorbidities, was 2.71 (CI: 2.59–2.84) for patients with diagnosed CKD and 1.38 (CI: 1.31–1.46) for those with proxy-diagnosed CKD. The adjusted all-cause mortality hazard ratios were 2.22 (CI: 1.95–2.52) for CKD-diagnosed patients and 1.31 (CI: 1.08–1.60) for those with a proxy-diagnosed CKD. Conclusion The study highlights gaps in CKD diagnosis and management, with many patients remaining undiagnosed despite meeting CKD criteria. Diagnosed CKD patients received better follow-up but faced higher risks of hospitalization and mortality due to more complex comorbidities and more advanced CKD. Proxy-diagnosed CKD were common and associated with suboptimal management. These findings emphasize the need for consistent and accurate CKD identification to improve outcomes and optimize care.

Up to 25% of youth experience a depressive episode by 18 years of age, leading the US Preventive Services Task Force to recommend depression screening within this population. This study aimed to understand the prevalence of depression identified within pediatric orthopedic clinics compared with primary care clinics after the implementation of a screening program and present data on the prevalence of moderate-severe depression across specific pediatric orthopedic clinics, characterizing and identifying specific populations at higher risk. A retrospective review was performed to identify all patients screened using the 2-item and 9-item versions of the Patient Health Questionnaire (PHQ-2/PHQ-9) and the Columbia-Suicide Severity Rating Scale over a 2-year period (October 2018 to January 2021) within pediatric primary care and orthopaedic clinics. Demographic and clinical characteristics were collected. Statistical analysis was performed to compare scores between orthopedic and primary care clinics, as well as between the different pediatric orthopedic subspecialties and included χ 2 test, ANOVA, and logistic regression. There were 32,787 unique adolescent patients screened in primary care clinics, with an additional 14,078 unique adolescent patients screened in orthopaedic clinics, leading to a 30% increase in the overall number of patients receiving depression screening. 5.2% of patients in primary care pediatric clinics screened positive for moderate-severe depression versus 2.0% in pediatric orthopaedic clinics ( P <0.001). 2.7% of primary care patients were at risk of self-harm compared with 0.8% of orthopedic patients ( P <0.001). Within orthopaedic subspecialty clinics, the spine patients were at the highest risk of moderate-severe depression (3.5%), significantly higher than both the sports (1.4%, P =0.006) and patients with acute fracture (1.3%, P <0.001). This study demonstrates the high incidence of patients screening positive for depression in pediatric and adolescent orthopaedic clinics. By identifying high-risk clinics and patient groups, health care systems can apply a more practical approach and appropriately deploy behavioral health specialists for timely counseling and treatment discussions. Level-III.

143: A Prospective Evaluation of Risk Factors Affecting the Severity of Pediatric Trampoline Injuries

Background: Early recognition of chronic kidney disease (CKD) is crucial to slow its progression, yet underdiagnosis remains high. This study assesses prevalence of and factors associated with undiagnosed stage 3 CKD in patients with pre-existing type 2 diabetes (T2D) . Methods: REVEAL-CKD is a multi-national secondary data study. Data were extracted from THIN (Cegedim Health Data, France) and Disease Analyzer (IQVIA, Germany) . Patients were aged ≥18 years with 2 consecutive estimated glomerular filtration rate (eGFR) results 30-59 mL/min/1.73 m2 recorded 90-730 days apart in 2015-2021. T2D was identified by a diagnosis code before 2nd eGFR. Patients with no CKD code before 1st eGFR and ≤6 months after 2nd eGFR were considered undiagnosed. Results: The cohorts included 3,532 patients with T2D and stage 3 CKD in France and 6,935 in Germany. In both cohorts, undiagnosed CKD was high (94% and 74%, respectively) , and was greater in those aged ≥65 years and in females. In patients with additional pre-existing comorbidities undiagnosed CKD remained high, ranging between 65% - 96% (Table 1) . Conclusion: A high prevalence of undiagnosed CKD in patients with T2D was observed for France and Germany. Older patients and females were particularly vulnerable to undiagnosed CKD. Considerable opportunities exist to increase early identification and proactive management of CKD to slow progression and improve outcomes. Disclosure M.P. Schneider: Consultant; AstraZeneca. J.B. Virgitti: Advisory Panel; AstraZeneca, Lilly, Novo Nordisk. E. Peach: Employee; AstraZeneca. Stock/Shareholder; AstraZeneca. S. Barone: Employee; AstraZeneca. M. Arnold: Employee; AstraZeneca. N. Tangri: Consultant; AstraZeneca, Bayer AG, Boehringer Ingelheim International GmbH, Janssen Pharmaceuticals, Inc., Otsuka America Pharmaceutical, Inc., Pulsedata, Renibus, Tricida, Inc. Stock/Shareholder; Clinpredict, Klinrisk.

Undiagnosed Chronic Kidney Disease in a Child With Fractures Presenting to a Pediatric Orthopedic Clinic.

Undiagnosed chronic kidney disease and its associated risk factors in an agricultural Moroccan adult's population

Undiagnosed chronic kidney disease (CKD) is common in people with diabetes mellitus. Validated noninvasive risk models are an attractive CKD screening option in diabetic patients to identify patients who are more likely to be diagnosed with CKD via biological tests. The study aimed to validate the Korean and Thai noninvasive CKD risk prediction models in African Type 2 diabetic patients. This was a hospital-based study. The Modification of Diet in Renal Disease (MDRD) and CKD Epidemiology Collaboration (CKD-EPI) equations were used to estimate the glomerular filtration rate (eGFR). CKD was defined as an eGFR <60 mL/min/1.73 m2, and any nephropathy as eGFR <60 mL/min/1.73 m2 and/or proteinuria. Discrimination was assessed and compared using c-statistics and non-parametric methods. Calibration performance was assessed before (original models) and after intercept adjustment. A total of 733 patients (421 men) aged 57.0 years (standard deviation = 10.4) were included. The MDRD equation identified 223 (30.4%) participants as having CKD and 377 (51.4%) participants with any nephropathy. The CKD-EPI equation identified fewer cases of CKD and any nephropathy with 194 (26.5%) and 357 (48.7%) cases, respectively. The original Korean model had the highest C-statistics of 0.696 (95% confidence interval: 0.654-0.739) for the outcome of eGFR <60 mL/min/1.73 m2 (using the CKD-EPI equation). Discrimination was significantly better in men, older and overweight participants. Intercept adjustment markedly improved calibration. Asian models have modest discrimination and good calibration with modest adjustment in predicting undiagnosed CKD in African diabetic patients; limiting their consideration for use in diabetes care in this setting.

Background and Aims Chronic Kidney Disease (CKD) is recognized as a health problem in the general population. The worldwide incidence of chronic kidney disease (CKD) is increasing, driven by aging populations and a higher prevalence of type 2 diabetes (T2D) and hypertension. The CKD is generally asymptomatic, and the diagnosis depends on the laboratory monitoring of the patients. The KDIGO consensus statement recommend the implementation of screening programs in patients at high risk of CKD development. We present the first results of a sentinel surveillance program of CKD in a healthcare area for detecting undiagnosed CKD in patients at risk. Method Our health department covers the metropolitan area of Valencia, attending 341, 972 citizens through 31 primary care centers. A CKD screening program has been established in this population based on a middleware clinical decision support (CDS) system “CDS-Ripple Down - Abbott Diagnostics” integrated in an electronic request system and in the electronic health records. When a general practitioner doctor order a lab test, the middleware CDS system detects high risk patients for CKD defined by age: &amp;gt;65 to &amp;lt;90, diabetes mellitus, hypertension, or obesity. Automatically, the system adds serum creatinine, estimated glomerular filtration rate (eGFR), urine albumin-to-creatinine ratio (UACR) and urine sediment analysis if it has not been requested (sentinel program). Then, the patients are classified into KDIGO stages based on eGFR and UACR and the CDS system detect those with progression (Fig. 1). Only patients with UACR &amp;gt; 300 mg/g, eGFR &amp;lt; 30 ml/min/1.73, or progression were referred to nephrology. A nephrologist then decides whether patients require a face-to-face visit or provides recommendations to primary care physicians. Results From 01/11/2023 to 31/12/2023, 4, 989 reports were generated by CDS-system corresponding to 122 laboratory test per day. 99, 33% were added by the sentinel program. 3, 970 (79.6%) patients did not have CKD (KDIGO G1-2 or UACR &amp;lt;30 mg/g), 887 (17.8%) patients CKD not suitable for referral to Nephrology (KDIGO 3 and UACR 30-300 mg/g without progression, and 130 (2, 6%) were referred to Nephrology. (Fig. 2) Patients referred to Nephrology had a median age of 79 years [IQR: 72-85], 68 (52, 3%) were women. Twenty-seven patients (20%) were classified as KDIGO G2 A3, 19 (14, 6%) as KDIGO G4 A1 and 18 (13, 8) as KDIGO G2 A2. Fifty-seven patients (43, 8%) have been scheduled to face-to-face at nephrology consultation (1.1% of the total sample), and 73 (56, 1%) have been referred to their primary care doctors with recommendations (1.5% of the total sample). Among the patients referred to Nephrology by the CDS system, the reasons for not scheduling a face-to-face visit in Nephrology were mild decrease in eGFR (n = 18), UACR A2 (n = 24), elderly patients with low Kidney Failure Risk Equation (n = 5), urological pathology (n = 10), dependent patient and/or palliative situation (n = 5) and other causes (n = 11). Conclusion A novel CKD automatic screening method for capturing undiagnosed CKD among patients at risk has been developed. After screening around 5 000 patients at risk in two months, 2.6% of them presented criteria for referral to Nephrology. Only 1.4% required face-to-face visit. If we continue at this screening rate, it is expected that half of our population at risk of developing CKD will have been screened in less than one year. Computer systems with algorithms programmed and improved by a multidisciplinary team can establish a sentinel route (reviewing patients medical records), interpreting analytical values (calculating progressions, KDIGO stages, KFRE risk...) and producing automatic interpretive reports that integrates all the elements of CKD clinical attention allowing us to carry out this population screening.

Background: Effective actions to slow chronic kidney disease (CKD) progression depend on early disease recognition. This study aimed to assess the prevalence of and factors associated with undiagnosed stage 3 CKD.Methods: REVEAL-CKD is a multinational initiative to assess undiagnosed CKD. From the US, we utilised TriNetX, a federated research network providing statistics on electronic health records. Adult patients, with two eGFR measurements ≥30 and <60 mL/min/1.732 at least 90 days apart, were identified between 2015-2020. The date of the second eGFR measurement was defined as the index date. Those with no CKD diagnosis code at any time before or up to 6 months after the index date were considered to have undiagnosed CKD.Results: The study cohort included 178,331 patients whose mean age at index date was 70.8 years (standard deviation (SD): 10.6). The proportion of patients with undiagnosed CKD was 62.4% (95% confidence interval [CI] 62.2 to 62.6). Patients with comorbidities or younger age had a lower undiagnosed rate (Table 1). Of 123,994 patients with undiagnosed CKD at the index date, 25% received a diagnosis at some point during follow-up, with a median time to diagnosis of 253 days.Conclusion: This study documented that a majority of stage 3 CKD patients were undiagnosed. These results suggest that an opportunity exists for more proactive CKD diagnosis and monitoring at early stages.View largeDownload slideView largeDownload slide DisclosureA. Abdul sultan: Employee; Self; AstraZeneca. S. Barone: Employee; Self; AstraZeneca. S. Kumar: Employee; Self; AstraZeneca, Stock/Shareholder; Self; AstraZeneca. H. Chen: None. K. Järbrink: Employee; Self; AstraZeneca. E. T. Wittbrodt: Employee; Self; AstraZeneca, Stock/Shareholder; Self; AstraZeneca. P. R. Kushner: Advisory Panel; Self; Abbott Diabetes, AstraZeneca, Boehringer Ingelheim Pharmaceuticals, Inc., Novo Nordisk, Speaker’s Bureau; Self; AstraZeneca, Janssen Pharmaceuticals, Inc., Lilly Diabetes, Novo Nordisk.

BackgroundOne million patients are estimated to have undiagnosed chronic kidney disease (CKD) in England. Clinical coding in CKD is associated with improved management and lower acute kidney injury (AKI), unscheduled care and mortality risk. Primary care’s role in coding CKD is well documented. However, there is scant evidence on CKD coding quality in secondary care. Primary aims: to measure total and coded/uncoded CKD prevalence on admission and discharge, and conversion of uncoded to coded CKD in secondary care. Secondary aims: to map coding status to kidney health inequality themes and to measure predictors of coding, death and AKI.MethodsRetrospective audit in an acute medical hospital ward in England, April 2022-February 2023. Descriptive statistics include counts/percentages for categorical data, prevalence estimates and rates. Logistic regression measured significant predictors (p = < 0.05) of receiving a diagnostic CKD code on discharge, risk of death, and of AKI.ResultsUncoded CKD prevalence using discharge estimated GFR (eGFR) was 58.7% (n = 283), equating to 1.1 cases uncoded CKD per bed/month and 13.7 cases uncoded CKD per bed/year. Conversion of uncoded to coded CKD at discharge was only 6.7%. Hypertension and advanced CKD were significant predictors of coding CKD on discharge in uncoded patients. Age, sex, indices of multiple deprivation, and AKI were significant predictors of death during admission. Advanced CKD was a significant predictor of AKI during admission.ConclusionsUncoded CKD is highly prevalent in an acute medical hospital ward highlighting opportunity to improve coding in another part of the health system in addition primary care.

BackgroundThere is limited knowledge of Chronic Kidney Disease (CKD) among high risk populations, especially in the developing countries. We report our study of testing for CKD in at-risk subjects.MethodsIn a cross-sectional study, 527 people from primary and secondary health care areas in the city of Kinshasa were studied from a random sample of at-risk out-patients with hypertension, diabetes, obesity, or HIV+. We measured blood pressure (BP), blood glucose level, proteinuria, body mass index, and estimated glomerular filtration rate (eGFR by MDRD equation) using calibrated creatinine levels based on one random measurement. The associations between health characteristics, indicators of kidney damage (proteinuria) and kidney function (<60 ml/min/1.73 m2) were also examined.ResultsThe prevalence of CKD in this study was 36%, but only 12% were aware of their condition. 4% of patients had stage 1 CKD, 6% stage 2, 18% stage 3, 2% stage 4, and 6% had stage 5. 24 hour quantitative proteinuria (>300 mg/day) was found in 19%. In those with the at-risk conditions, the % of CKD was: 44% in patients with hypertension, 39% in those with diabetes; 16% in the obese and 12% in those who were HIV+. 82% of those with a history of diabetes had elevated serum glucose levels at screening (≥ 126 mg/dl). Only 6% of individuals with hypertension having CKD had reduced BP to lower than 130/80 mmHg. In multivariate analysis, diabetes, proteinuria and hypertension were the strongest determinants of CKD 3+.ConclusionIt appears that one out of three people in this at-risk population has undiagnosed CKD and poorly controlled CKD risk factors. This growing problem poses clear challenges to this developing country. Therefore, CKD should be addressed through the development of multidisciplinary teams and improved communication between traditional health care givers and nephrology services. Attention to CKD risk factors must become a priority.

Chronic kidney disease (CKD) is a progressive condition that can lead to kidney failure and the requirement for renal dialysis or transplantation. Early-stage CKD is often missed because the disorder is initially asymptomatic; hence, many patients with CKD already have symptomatic advanced disease (Stages G4–G5) at the time of diagnosis. This is an important issue because the drugs available for the treatment of CKD are most effective when given during the early stages of the disease (Stages G1–G3). EMJ conducted interviews in July 2022 with two key opinion leaders, Navdeep Tangri from the University of Manitoba, Winnipeg, Canada, and Luca De Nicola from the University of Campania Luigi Vanvitell, Naples, Italy, both of whom have a wealth of experience in the management of patients with CKD. The experts provided important insights into the ongoing REVEAL-CKD study, which was designed to explore the global prevalence of undiagnosed Stage G3 CKD. This article describes the main findings of the REVEAL-CKD study published to date and their implications. Possible approaches to improving the diagnosis of CKD are also discussed.