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Chronic kidney disease in general practice: prevalence, diagnosis, and standards of care
L G Glynn1, J Anderson, D Reddan
1Department of General Practice, National University of Ireland, Galway. liam.glynn@nuigalway.ie
Insights
Chronic kidney disease (CKD) is prevalent in Irish primary care, affecting 16.7% of adults over 50. However, CKD remains largely undiagnosed, impacting patient care and risk management.
Area of Science:
- Nephrology
- Primary Care Medicine
- Epidemiology
Background:
- Limited prevalence data exists for chronic kidney disease (CKD) in Ireland.
- Low rates of CKD diagnosis in primary care settings have been suggested.
- CKD diagnosis is crucial for effective patient management and risk factor control.
Purpose of the Study:
- To determine the prevalence of CKD in a primary care population in Ireland.
- To assess the diagnostic rates and standards of care for patients with CKD.
- To investigate the impact of CKD diagnosis on management and risk factor control.
Main Methods:
- Cross-sectional study analyzing patient records from three general practices in West Ireland.
- Inclusion criteria: 2602 community-dwelling patients aged over 50 years.
- CKD defined as estimated glomerular filtration rate (eGFR) <60 ml/min/1.73 m2; diagnosis documented in patient records.
Main Results:
- 16.7% of patients (435/2602) had CKD (eGFR <60 ml/min/1.73 m2).
- Only 13.3% (58/435) of those with CKD had a documented diagnosis.
- Documented CKD diagnosis correlated with increased ACE/ARB prescription, lipid-lowering agent use, and ACR/PCR testing.
Conclusions:
- CKD is common in Irish primary care but frequently undiagnosed.
- Documenting CKD diagnosis is a key step towards improving patient care standards and risk factor management.
- Blood pressure control remains suboptimal in the majority of patients, irrespective of CKD diagnosis.
Abstract:
There is little prevalence data for chronic kidney disease (CKD) in Ireland and it has been suggested that rates of diagnosis of CKD in primary care are low. The aim of this cross sectional study was to examine the prevalence, diagnosis and standards of care for CKD. All patient records in three general practices in the West of Ireland were reviewed. In 2602 patients > 50 years in the community, 435 (16.7%) had chronic kidney disease defined as eGFR <60 ml/min/1.73 m2. Of these 435 individuals, only 58 (13.3%) had a diagnosis of CKD documented in their patient record. Among all patients with an eGFR <60 ml/min/1.73 m2, those with a documented diagnosis of CKD were significantly more likely to be prescribed an ACE/ARB and a lipid-lowering agent and were more likely to have had an ACR/PCR checked in the previous twelve months. Blood pressure was being appropriately monitored in the majority of patients but irrespective of eGFR level or a documented diagnosis of CKD, less than a fifth of patients had achieved a target of <130/80 mmHg. CKD is common in primary care but remains largely undiagnosed and blood pressure control remains suboptimal. A key step in improving care appears to be documenting the diagnosis which in turn appears to lead to improved standards of care and risk factor management.
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