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Renal impairment in elderly patients with hypertension and diabetes
1Renal Unit, Kings College Hospital, London, UK.
Insights
Renal impairment is common in hypertensive and diabetic patients aged 50-75. Simple screening for kidney disease in this high-risk group yields many positive results.
Area of Science:
- Nephrology
- Cardiology
- Endocrinology
Background:
- Hypertension and diabetes are major risk factors for chronic kidney disease (CKD).
- Early detection of renal impairment is crucial for timely intervention and management.
- A significant portion of the population with these comorbidities may have undiagnosed renal issues.
Purpose of the Study:
- To determine the prevalence of renal impairment and proteinuria in individuals aged 50-75 with hypertension or diabetes.
- To assess the effectiveness and yield of screening for renal disease in this at-risk population.
Main Methods:
- Retrospective analysis of serum creatinine levels from biochemistry databases.
- Prospective screening invitations for individuals with unrecorded creatinine results.
- Data collection on renal function markers and blood pressure control in a general practice setting.
Main Results:
- Overall prevalence of renal disease was 8.4% (using serum creatinine > 120 mmol/l).
- Prevalence was higher in diabetics (12.6%) and those with both conditions (16.9%) compared to hypertensives (6.1%).
- Significant proteinuria (≥2+) was found in 3.9% of the total population, notably higher in diabetics (8.3%).
- 44.5% of participants had inadequately controlled blood pressure at screening.
Conclusions:
- Renal impairment is highly prevalent in patients aged 50-75 with hypertension and/or diabetes.
- Screening for renal disease in this population is straightforward, safe, and identifies a substantial number of affected individuals.
- The findings underscore the need for regular renal function monitoring in patients with these risk factors.
Abstract:
We investigated the prevalence of renal impairment in individuals with known hypertension or diabetes aged 50--75 years in two South London General PRACTICES: We initially interrogated the practice and hospital biochemistry databases for each individual's most recent serum creatinine. Individuals with no result recorded in the previous year were then invited for screening: 189/365 (51.8%) attended. Data were collected on 821 of a total potential population of 997. Taking a serum creatinine of 120 mmol/l as the upper limit of normal, the overall prevalence of renal disease in this population was 8.4%: 6.1% in the hypertensives, 12.6% in the diabetics and 16.9% in those with both. Significant proteinuria (> or =2+) was present in 3.9% of the total population: 2.2% of hypertensives, 8.3% of diabetics and 3.9% of those with both. At screening, 44.5% of individuals had inadequately controlled blood pressure. Renal impairment is common in this population at high risk of renal disease. Screening for renal disease in this population is simple, safe and gives a high yield of positive results.