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Identifying chronic kidney disease in an emergency department: a chance for an early diagnosis
Krystyna Rohun1, Marzena Kuliś, Anna Pawłowska
1Department of Nephrology, Hypertension and Internal Medicine, University of Warmia and Mazury, Olsztyn, Poland.
Insights
Emergency departments can identify many patients with undiagnosed chronic kidney disease (CKD). However, current screening practices for early CKD detection are underutilized, necessitating a structured ED screening program.
Area of Science:
- Nephrology
- Emergency Medicine
- Public Health
Background:
- Chronic kidney disease (CKD) often presents asymptomatically, yet significantly worsens patient prognosis due to increased cardiovascular disease risk.
- Early diagnosis of CKD is crucial for improving outcomes, prompting investigations into effective screening strategies.
- Emergency departments (EDs) represent a potential setting for identifying individuals with early-stage CKD.
Purpose of the Study:
- To evaluate the diagnostic accuracy of current emergency department (ED) practices for detecting chronic kidney disease (CKD).
Main Methods:
- A study involving 176 patients admitted to a general hospital from the ED over one month.
- Key parameters measured included blood pressure, serum creatinine, estimated glomerular filtration rate (eGFR), urea, potassium, and glucose.
- Patients with a prior diagnosis of CKD were excluded.
Main Results:
- Elevated blood pressure (>140/90 mmHg) was observed in 63% of patients.
- Creatinine levels exceeded the upper limit (1.2 mg/dl) in 27.3% of samples, and eGFR was below 90 ml/min/1.73 m² in 64.8%.
- Abnormal urea levels (>50 mg/dl) were found in 32%, and elevated glucose (>110 mg/dl) in 60% of patients.
Conclusions:
- ED practices can effectively identify a substantial number of patients with previously undiagnosed CKD.
- Simple, cost-effective methods for early CKD detection are currently underutilized in the ED setting.
- There is an urgent need to implement a structured CKD screening program within emergency departments.
Introduction:
Chronic kidney disease (CKD) has relatively asymptomatic course, but even at its onset, it worsens the prognosis of patients, mainly because of the increased risk of cardiovascular diseases. Several population-based screening programs as well as initiatives focused on certain risk groups were undertaken to better diagnose early stages of CKD. It appears that an emergency department (ED) of a hospital may be the right place to screen for early CKD.
Objectives:
The aim of the study was to assess the accuracy of ED practices in the detection of CKD.
Patients And Methods:
The study involved 176 subjects who presented at the ED over 1 month and were subsequently admitted to one of the wards at the general hospital. Blood pressure on admission was recorded in 61% of the patients; serum creatinine and estimated glomerular filtration rate (eGFR) were measured in 50% of the subjects, urea in 42.2%, potassium in 87.5%, and glucose in 82%. Patients with previously diagnosed CKD were excluded from the study.
Results:
Sixty-three per cent of blood pressure values exceeded 140/90 mmHg, 27.3% of all creatinine samples exceeded the upper limit of 1.2 mg/dl, and 64.8% of eGFR results were below 90 ml/min/1.73 m² (mean 78 ± 36 ml/min/1.73 m²). Abnormal levels of urea (>50 mg/dl) were observed in 32% of the patients. Potassium levels were within the reference range in 81.5% of the patients (3.5-5.0 mmol/l; only 10.4% exceeding 5 mmol/l). Elevated glucose levels (>110 mg/dl) were observed in 60% of the patients.
Conclusions:
ED practices could be used to identify a significant number of patients with undiagnosed CKD. However, these simple, widely available, and cost-effective methods of early CKD detection are underused. Our results show that there is an urgent need for a structural screening program for CKD at the level of ED.
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