Undiagnosed Chronic Kidney Disease Research Articles

#2617 Impact of CKD screening in high‑risk populations and guideline-directed therapy on RRT, CV events, and mortality in Europe: an IMPACT CKD analysis

Abstract Background and Aims Despite the rising and substantial burden of chronic kidney disease (CKD), there is a lack of recognition of CKD as a health priority in Europe. This contributes to underdiagnosis of CKD despite the potential for early detection and effective intervention to delay progression to late-stages (associated with costly and resource-intensive renal replacement therapy [RRT; i.e., dialysis and transplantation]). Further, diagnosed patients are undertreated when compared to current and upcoming CKD guidelines, leading to increased risk for progression to RRT and cardiovascular (CV) or other events. Early detection and intervention in high-risk populations, such as those with diabetes mellitus (DM) and hypertension (HTN) have shown cost-effectiveness; however, the broader implications of these strategies on CKD progression and clinical outcomes in a European context remains underexplored. Our study aims to illustrate the clinical benefit of targeted screening followed by an optimal compliance to guideline-directed treatment use to provide insight into potential CKD policies across Europe. Method Four country populations (Germany, Netherlands, Spain, United Kingdom [UK]) were simulated for 10-years (baseline: 2022; simulated years: 2023-2032) using the validated IMPACT CKD model to compare two scenarios: targeted screening for people with DM and/or HTN followed by 90% compliance to guideline-directed therapy versus current practice (i.e., underdiagnosis without screening and low treatment rates). Annual targeted screening was modelled using estimated glomerular filtration rate (eGFR) and urine albumin-creatinine ratio (UACR) testing. Initiation of therapies for people with diagnosed CKD was based on Kidney Disease Improving Global Outcomes guidelines. A 90% compliance to guideline-directed therapies was assumed to approximate maximum clinical benefit. Current practice was modelled based on the observed diagnosed rate without screening and the observed treatment rate in each country. The incremental population initiated on recommended therapies were modelled to experience a multiplicative treatment effect on GFR decline, CV events, and acute kidney injury (AKI) events. The model projected CKD and RRT prevalence, incidence of CV and AKI events with results shown for year 10 (2032), as well as cumulative all-cause mortality over the simulated 10-years. Results Results compare the high-risk population screening followed by guideline-directed treatment scenario to continuation of current practices for the four countries (Fig. 1). The identification of undiagnosed CKD, as well as lower rates of progression due to guideline-directed treatment was associated with a small rise in the number of total CKD patients, with increases in stage 1-2 by 3.5% to 5.0%, and stage 3-5 by 0.2% to 1.2%. There was a reduction in the number of undiagnosed CKD stage 1-2 patients by 49.2% to 71.6%, and stage 3-5 by 60.2% to 69.8%. The largest reductions were predicted for CV events (44.6% to 49.1%) followed by dialysis (22.6% to 41.9%). The strategy resulted in a decrease in cumulative 10-year all-cause mortality between 4.5% to 9.1% in CKD patients. Conclusion The study predicted significant clinical benefits from targeted CKD screening followed by guideline-directed interventions across all four European countries. Notably, this approach was forecasted to reduce undiagnosed CKD cases, dialysis, CV events, and mortality. These findings underscore the potential of acting earlier on CKD to mitigate the future CKD burden.

#2745 New strategies for capturing undiagnosed chronic kidney disease in patients at risk

Abstract 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: >65 to <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 > 300 mg/g, eGFR < 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 <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.

Are there lost opportunities in chronic kidney disease? A region-wide cohort study

ObjectivesIdentify the windows of opportunity for the diagnosis of chronic kidney disease (CKD) and the prevention of its adverse outcomes and quantify the potential population gains of such prevention.Design and...

304 Uncovering the Burden of Undiagnosed Chronic Kidney Disease in US Healthcare Systems

304 Uncovering the Burden of Undiagnosed Chronic Kidney Disease in US Healthcare Systems

Community pharmacist-led point-of-care eGFR screening: early detection of chronic kidney disease in high-risk patients

Adherence to scheduled physician screenings for renal function monitoring in patients with chronic kidney disease (CKD) or those at high risk remains suboptimal despite the endorsement of regular screenings by several clinical practice guidelines. Our study aims to assess the effectiveness of a point-of-care CKD screening program led by these pharmacists using the PICCOLO device while recognizing the unique position of community pharmacists in primary care. We conducted an 11-month prospective point-of-care interventional research study in the United Arab Emirates to evaluate the performance of a community pharmacist-led CKD screening program for high-risk patients. Six diverse community pharmacies were selected based on staff availability, patient volume, and their offered range of services. Eligible individuals with risk factors for CKD were identified during medication evaluations. The PICCOLO Comprehensive Metabolic Panel facilitated on-site blood analysis, delivering estimated Glomerular Filtration Rate (eGFR) results within 10 to 15 min. Data also included eGFR categories, demographic information, and insights into lifestyle and health habits collected through a questionnaire. Pharmacists conducted comprehensive medication reviews and offered referrals and lifestyle guidance as part of the program. The study encompassed a total of 400 patients, with an average age of 69 ± 13.4 years within the study cohort. Notably, 38.8% (155 individuals) of the 400 patients were found to have undiagnosed CKD stages 3–5. Univariate logistic regression analysis revealed a significant association between a higher incidence of CKD stages 3–5 and factors such as older age, a history of hypertension, vascular disease, and diabetes mellitus. In the multivariate regression model, age and a history of diabetes mellitus emerged as significant predictors of an elevated risk of CKD. This study sheds light on the viability and impact of CKD screening programs conducted by community pharmacists, particularly in detecting CKD stages 3–5. The findings have implications for healthcare policies, as they can influence the enhancement of early detection and management of CKD. Moreover, these insights may catalyze focused screening initiatives and strengthen collaboration between community pharmacies and healthcare systems to benefit patients at high risk of CKD.

Targeted Screening for Undiagnosed Chronic Kidney Disease among Asymptomatic Immediate Family Members of Chronic Kidney Disease Patients: Experience from a Teaching Hospital in South Eastern Nigeria

Background: Chronic Kidney Disease (CKD) is a worldwide epidemic that is associated with a huge morbidity, mortality and high healthcare cost. In Nigeria, the number of patients with CKD progressing to End Stage Renal Disease (ESRD) is increasing. Early screening of individuals who are at risk of CKD has been advocated by several studies because it would reduce the morbidity and mortality associated with late presentation. Studies have found that the immediate family members/First-Degree Relatives (FDRs) of CKD patients have a greater prevalence of CKD compared with the general population and hence should be screened for kidney disease at any available opportunity.

Resting heart rate is associated with the prevalence of chronic kidney disease in Korean adult: the Korean National Health and Nutrition Survey.

Chronic kidney disease (CKD) poses a significant health challenge, yet early detection remains difficult. Resting heart rate (RHR) has been shown to be a reliable indicator of type 2 diabetes, prompting interest in its potential as an independent predictor of CKD. This study aimed to investigate the association between RHR and CKD prevalence, as well as explore potential interactions between RHR and other risk factors for CKD in a sample of 25,246 adults. Data from the Korean National Health and Nutrition Examination Survey (2011-2014) were utilized for this study, with 19,210 participants included after screening. Logistic regression analysis was employed to examine the relationship between RHR and CKD prevalence. Stratified analyses were conducted based on known risk factors for CKD. Participants with an RHR ≥ 90bpm exhibited a 2.07-fold [95% confidence interval (CI): 1.28-3.34] and 2.22-fold (95% CI: 1.42-3.48) higher prevalence of CKD in men and women, respectively, compared to those with an RHR < 60bpm. The association between RHR and CKD prevalence was particularly pronounced in younger participants (40-59years vs. ≥ 60years), individuals with diabetes (yes vs. no), and those with a longer duration of diabetes (≥ 7years vs. < 7years). Elevated RHR was found to be significantly associated with a higher prevalence of CKD in both men and women, independent of demographic, lifestyle, and medical factors. These findings suggest that RHR could serve as a valuable predictor for undiagnosed CKD.

Incidence of, and Risk Factors and Outcomes Associated with, Acute Kidney Injury in COVID-19 at the National Kidney and Transplant Institute, Philippines.

(1) Background: Acute kidney injury (AKI) in COVID-19 leads to an increase in patient mortality, especially among chronic kidney disease (CKD) patients. (2) Methods: A retrospective cohort of 519 adults admitted from 1 March 2020 to 1 March 2022 were reviewed for baseline characteristics and their association with renal outcomes. Patients were divided into diagnosed CKD, undiagnosed CKD, and normal eGFR. Chronic dialysis and kidney-transplant patients were excluded. Kaplan-Meier survival analysis at 7, 14, and 30 days from admission was performed. (3) Results: The overall incidence of AKI was 45.66%; the proportions among patients with diagnosed CKD, undiagnosed CKD, and normal eGFR were 76.64%, 38.75%, and 7.59%, respectively (p < 0.0001). Multivariate analysis showed that being male and inotrope use were significant risk factors for AKI, while higher eGFR was protective. AKI was associated with dialysis, invasive ventilation (p < 0.0001), prolonged hospitalization (p = 0.0001), and mortality (p < 0.0001). Renal recovery was 64%, 59%, and 23% in stages 1, 2, and 3 AKI, respectively, until 14 days from discharge (p < 0.0001). Patient survival was lower in cases of AKI: 83.16%, 70.59%, and 47.5% compared to non-AKI figures of 91.27%, 87.82%, and 76.95% at 7, 14, and 30 days respectively(p = 0.0001). (4) Conclusion: There was a higher incidence of AKI with worsening renal function. Intensified preventive measures for AKI are crucial to prevent its devastating consequences.

#3471 INCIDENCE, RISK FACTORS AND OUTCOMES ASSOCIATED WITH ACUTE KIDNEY INJURY IN COVID-19 AT THE NATIONAL KIDNEY AND TRANSPLANT INSTITUTE

Abstract Background and Aims Acute kidney injury (AKI) in COVID-19 leads to an increase in patient mortality especially among chronic kidney disease (CKD) patients. This study aims to determine the incidence and risk factors for AKI and compare renal outcomes and survival among patients with and without AKI admitted for Covid-19 at a tertiary renal center. Methods A retrospective cohort of 519 adult patients admitted from March 1,2020 to March 1, 2022, reviewed baseline characteristics and their association with renal outcomes. Patients were divided according to diagnosed CKD, undiagnosed CKD and normal eGFR. Chronic dialysis and kidney transplant patients were excluded. Kaplan-Meier survival at 7, 14 and 30 days from admission was performed. Patients were followed up to 14 days from discharge. Results Overall incidence of AKI was 45.66%; 76.64%, 38.75%, 7.59% among patients with diagnosed CKD, undiagnosed CKD and normal eGFR respectively (p&amp;lt;0.0001). Multivariate analysis showed males and inotrope use were significant risk factors for AKI, while higher eGFR was protective. AKI was associated with dialysis, invasive ventilation (p&amp;lt;0.0001), prolonged hospitalization (p = 0.0001) and mortality (p&amp;lt;0.0001). Renal recovery was 64%, 59%, 23% in stage 1, 2 and 3 AKI respectively, until 14 days from discharge (p&amp;lt;0.0001). No significant difference was observed with renal recovery and COVID-19 severity. Patient survival was lower with AKI, 83.16%, 70.59%, 47.5% compared to non-AKI, 91.27%, 87.82, 76.95% at 7, 14, and 30 days respectively (p = 0.0001). Conclusion There was a higher incidence of AKI with worsening renal function. Intensified preventive measures for AKI is crucial to prevent its devastating consequences.

Prevalence of undiagnosed stage 3 chronic kidney disease in France, Germany, Italy, Japan and the USA: results from the multinational observational REVEAL-CKD study

ObjectivesREVEAL-CKD aims to estimate the prevalence of, and factors associated with, undiagnosed stage 3 chronic kidney disease (CKD).DesignMultinational, observational study.SettingData from six country-specific electronic medical records and/or insurance claims databases...

Health care costs associated with unrecognized progression to late-stage kidney disease.

Many individuals with chronic kidney disease (CKD) are undiagnosed or unaware of the disease and at risk of not receiving services to manage their condition and of "crashing" into dialysis. Past studies report higher health care costs among patients with delayed nephrology care and suboptimal dialysis initiation, but they are limited because they focused on patients undergoing dialysis and did not evaluate costs associated with unrecognized disease for patients "upstream," or patients with late-stage CKD. We compared costs for patients with unrecognized progression to late-stage (stages G4 and G5) CKD and end-stage kidney disease (ESKD) with costs for individuals with prior CKD recognition. Retrospective study of commercial, Medicare Advantage, and Medicare fee-for-service enrollees 40 years and older. Using deidentified claims data, we identified 2 groups of patients with late-stage CKD or ESKD, one group with prior evidence of CKD diagnosis and the other without, and compared total and CKD-related costs in the first year following late-stage diagnosis between the 2 groups. We used generalized linear models to determine the association between prior recognition and costs and used recycled predictions to calculate predicted costs. Total and CKD-related costs were 26% and 19% higher, respectively, for patients without prior diagnosis compared with those with prior recognition. Total costs were higher both for unrecognized patients with ESKD and unrecognized patients with late-stage disease. Our findings indicate that costs associated with undiagnosed CKD extend to patients not yet requiring dialysis and highlight potential savings from earlier disease detection and management.

Findings and Implications of the REVEAL-CKD Study Investigating the Global Prevalence of Undiagnosed Stage G3 Chronic Kidney Disease

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.

Measuring kidney function: the voice of Africa

Measuring kidney function: the voice of Africa

Stagewise Classification of Chronic Kidney Disease and Diet Plan Recommendation

Abstract: Chronic kidney disease means gradual loss in functioning of kidney. Undiagnosed Chronic Kidney Disease can be identified, predicting the patient condition and its prevention with machine Learning Techniques. Accurate analytical models can be formed by medical practices, which decreases consequences hence gradually progresses specifications. To estimate Chronic Kidney Disease and to identify the stages in it. Dietary plan will be recommended based on the stages of Chronic Kidney Disease. There are no symptoms of Chronic Kidney Disease at earlier stages and if the disease remains unrectified then it can lead to kidney failure. Manual examination of Chronic Kidney Disease is a possible solution however it is dependent on human errors. Detecting Chronic Kidney Disease at early stage can help doctor to give better medication and patient may recovers soon.

1213-P: REVEAL-CKD: Undiagnosed Chronic Kidney Disease in Patients with Type 2 Diabetes in Germany and France

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.

Abstract P023: A Scoring Tool For Identifying Hispanics/latinos With Chronic Kidney Disease: Hispanic Community Health Study/study Of Latinos

Introduction: Despite the high prevalence of chronic kidney disease (CKD) in the Hispanic/Latino population, most Hispanic/Latino adults with CKD are not aware. This study aims to develop a tool for the Hispanic/Latino population to determine whether an individual has CKD. Methods: Baseline (2008-2011) data on 13,636 participants (aged 18 – 74 years; 60.8% female) from the Hispanic Community Health Study/Study of Latinos were analyzed to develop a tool using routinely available information to identify individuals with an increased likelihood of having CKD. CKD was defined as a low eGFR (&lt;60 ml/min per 1.73 m 2 ) or the presence of albuminuria [urine albumin to creatinine ratio (UACR)≥30 mg/g]. Based on prior literature, several CKD risk factors were examined using several prediction algorithms (RIDGE regression, LASSO regression, classification and regression tree, and random forest). Results: A total of 364 (2.7%) individuals had low eGFR and 1346 (10.1%) had albuminuria. The LASSO model was selected due to its greater accuracy and parsimony. Variables predictive of CKD were weighted to develop a model-based numeric scoring system. Age, self-reported health conditions (i.e., hypertension, diabetes, prevalent coronary heart disease/stroke, balloon angioplasty/stent/bypass surgery), physical functioning limitations, and having health insurance were predictive of low eGFR (Table). Diabetes, hypertension, and pulse were predictive of albuminuria (Table). Multivariate models were internally validated using 10-fold cross-validation (area under the receiver operating characteristic curve of 0.87 and 0.70 for low eGFR and albuminuria, respectively). A score of ≥9 on the eGFR model yielded sensitivity (SN) of 84%, specificity (SP) of 78%, positive predictive value (PPV) of 9%, and negative predictive value (NPV) of 99%. A score of ≥4 on the albuminuria model yielded SN of 62%, SP of 67%, PPV of 18%; and NPV of 94%. Conclusion: This community tool may facilitate the identification of undiagnosed CKD in Hispanics/Latinos.

Systematic review of diagnostic and prognostic models of chronic kidney disease in low-income and middle-income countries

ObjectiveTo summarise available chronic kidney disease (CKD) diagnostic and prognostic models in low-income and middle-income countries (LMICs).MethodSystematic review (Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines). We searched Medline,...

Validation of Two Asian Noninvasive Risk Models for Predicting Prevalent Undiagnosed Chronic Kidney Disease in Diabetic Patients Receiving Care at a Reference Hospital in A Sub-Saharan African Country: A Cross-Sectional Study.

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.

Investigating the global prevalence and consequences of undiagnosed stage 3 chronic kidney disease: methods and rationale for the REVEAL-CKD study.

ABSTRACTBackgroundTimely diagnosis and treatment of stage 3 chronic kidney disease (CKD) can prevent further loss of kidney function and progression to kidney failure. However, contemporary data on the global prevalence of undiagnosed stage 3 CKD are scarce. REVEAL-CKD is a multinational, multifocal and observational study aiming to provide insights into undiagnosed stage 3 CKD in a large population.MethodsPatients (aged ≥18 years) with data in selected secondary databases from 11 countries will be included if they have at least two estimated glomerular filtration rate (eGFR) measurements from 2015 onwards that are ≥30 and <60 mL/min/1.73 m2, recorded >90 and ≤730 days apart. Undiagnosed cases are those without an International Classification of Diseases 9/10 diagnosis code for CKD (any stage) any time before and up to 6 months after the second qualifying eGFR measurement. Time to diagnosis will be assessed using a Kaplan–Meier approach; patient characteristics associated with undiagnosed CKD will be assessed using adjusted logistical regression analyses.ResultsREVEAL-CKD will assess the point prevalence of undiagnosed stage 3 CKD and time to CKD diagnosis in initially undiagnosed cases overall and in individual countries. Trends in undiagnosed CKD prevalence by calendar year will be assessed. Patient characteristics, healthcare resource utilization, adverse clinical outcomes, and CKD management and monitoring practices in patients with versus without a CKD diagnosis will be compared.ConclusionsREVEAL-CKD will increase awareness of the global clinical and economic burden of undiagnosed stage 3 CKD and provide valuable insights to inform clinical practice and policy changes.

Hypertension and cardiovascular\xa0risk factor management in a\xa0multi-ethnic cohort of\xa0adults with CKD: a cross sectional study in general practice

BackgroundHypertension, especially if poorly controlled, is a key determinant of chronic kidney disease (CKD) development and progression to end stage renal disease (ESRD).AimTo assess hypertension and risk factor management, and determinants of systolic blood pressure control in individuals with CKD and hypertension.Design and settingCross-sectional survey using primary care electronic health records from 47/49 general practice clinics in South London.MethodsKnown effective interventions, management of hypertension and cardiovascular disease (CVD) risk in patients with CKD Stages 3–5 were investigated. Multivariable logistic regression analysis examined the association of demographic factors, comorbidities, deprivation, and CKD coding, with systolic blood pressure control status as outcome. Individuals with diabetes were excluded.ResultsAdults with CKD Stages 3–5 and hypertension represented 4131/286,162 (1.4%) of the total population; 1984 (48%) of these individuals had undiagnosed CKD without a recorded CKD clinical code. Hypertension was undiagnosed in 25% of the total Lambeth population, and in patients with CKD without diagnosed hypertension, 23.0% had systolic blood pressure > 140 mmHg compared with 39.8% hypertensives, p < 0.001. Multivariable logistic regression revealed that factors associated with improved systolic blood pressure control in CKD included diastolic blood pressure control, serious mental illness, history of cardiovascular co-morbidities, CKD diagnostic coding, and age < 60 years. African ethnicity and obesity were associated with poorer systolic blood pressure control.ConclusionWe found both underdiagnosed CKD and underdiagnosed hypertension in patients with CKD. The poor systolic blood pressure control in older age groups ≥ 60 years and in Black African or obese individuals is clinically important as these groups are at increased risk of mortality for cardiovascular diseases.Graphic abstract