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Updated: Jun 24, 2025
Assessment of Vascular Function in Patients With Chronic Kidney Disease
Published on: June 16, 2014
Patterns of kidney function and risk assessment in a nationwide laboratory database: the Brazilian CHECK-CKD study
Murilo Guedes1,2, Paulo Telles Dias3, Rosângela R Réa4
1Center for Epidemiological Research (EPICENTER), Curitiba, Brazil.
Insights
In Brazil, many patients with creatinine tests miss albuminuria assessments, hindering early chronic kidney disease (CKD) detection. Non-nephrologists manage most kidney function evaluations, emphasizing the need for improved CKD care practices.
Area of Science:
- Nephrology
- Public Health
- Clinical Practice
Background:
- Chronic kidney disease (CKD) presents a growing global health challenge.
- Early detection and risk stratification are crucial for preventing kidney failure.
- Data on kidney function assessment practices, especially in lower-income nations, are limited.
Purpose of the Study:
- To analyze practice patterns of kidney function assessment in Brazil.
- To determine the proportion of patients with serum creatinine tests who also received albuminuria assessments.
- To identify specialties involved in kidney function evaluation.
Main Methods:
- Retrospective observational analysis of a nationwide Brazilian laboratory database.
- Inclusion of adult patients with serum creatinine assessments between June 2018 and May 2021.
- Assessment of the co-occurrence of estimated glomerular filtration rate (eGFR) and predicted albumin-to-creatinine ratio (pACR) within 12 months.
Main Results:
- 42% of serum creatinine measurements lacked concurrent pACR assessments within 12 months.
- 10.8% of tests indicated potential CKD, predominantly stage 3a.
- Serum creatinine tests were primarily ordered by Internal Medicine, Cardiology, and Obstetrics/Gynecology; Nephrology accounted for only 1.1%.
Conclusions:
- A substantial number of Brazilian patients with creatinine tests do not undergo recommended albuminuria measurement.
- Non-nephrologists conduct most kidney function evaluations, including for patients with advanced CKD.
- There is a critical need to integrate early CKD detection and foster multidisciplinary care in clinical practice.
Background:
Chronic kidney disease (CKD) is a global health problem with rising prevalence, morbidity, mortality, and associated costs. Early identification and risk stratification are key to preventing progression to kidney failure. However, there is a paucity of data on practice patterns of kidney function assessment to guide the development of improvement strategies, particularly in lower-income countries.
Methods:
A retrospective observational analysis was conducted in a nationwide laboratory database in Brazil. We included all adult patients with at least one serum creatinine assessment between June 2018 and May 2021. Our primary objective was to determine the proportion of patients with estimated glomerular filtration rate (eGFR) evaluations accompanied by predicted levels of urinary albumin-to-creatinine ratio (pACR) assessments within 12 months.
Results:
Out of 4,5323,332 serum creatinine measurements, 42% lacked pACR measurements within 12 months. Approximately 10.8% of tests suggested CKD, mostly at stage 3a. The proportion of serum creatinine exams paired with pACR assessment varied according to the CKD stage. Internal Medicine, Cardiology, and Obstetrics/Gynecology were the specialties requesting most of the creatinine tests. Nephrology contributed with only 1.1% of serum creatinine requests for testing.
Conclusion:
Our findings reveal that a significant proportion of individuals with a creatinine test lack an accompanying urinary albuminuria measurement in Brazil, contrary to the recommendations of the international guidelines. Non-Nephrologists perform most kidney function evaluations, even among patients with presumable advanced CKD. This highlights the urge to incorporate in clinical practice the early detection of CKD and to encourage more collaborative multidisciplinary care to improve CKD management.
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