Treating chronic kidney disease in Danish primary care: results from the observational ATLAS study
Morten Lindhardt1,2, Søren Tang Knudsen3,4, Thomas Saxild5,6
1Department of Internal Medicine, Holbaek Hospital, Holbaek, Denmark. moli@regionsjaelland.dk.
Insights
Primary care physicians show awareness of chronic kidney disease (CKD) guidelines but underutilize cardio-renoprotective treatments, particularly in patients without diabetes or heart failure. This highlights a need for improved implementation strategies for early kidney protection.
Area of Science:
- Nephrology
- Primary Care Medicine
- Cardiovascular Health
Background:
- Chronic kidney disease (CKD) affects a significant portion of the primary care population.
- Effective management of CKD is crucial for preventing cardiovascular complications and slowing disease progression.
Purpose of the Study:
- To characterize clinical features, comorbidities, and treatments in primary care patients with CKD.
- To evaluate primary care physicians' (PCPs) diagnostic and management practices for impaired kidney function.
- To assess the uptake of cardio-renoprotective agents like renin-angiotensin-aldosterone system inhibitors (RAASis) and sodium-glucose co-transporter 2 inhibitors (SGLT2is).
Main Methods:
- An observational study utilizing electronic health records and physician questionnaires in Danish primary care settings.
- 1,497 CKD patients were identified based on estimated glomerular filtration rate (eGFR) or albuminuria criteria.
- Data included demographics, clinical variables, comorbidities, and prescribed medications.
Main Results:
- Hypertension (80%) and diabetes (32%) were prevalent comorbidities in the CKD population.
- Angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers (ACEis/ARBs) and statins were prescribed to 65% and 56% of patients, respectively.
- Sodium-glucose co-transporter 2 inhibitor (SGLT2i) use was low (14%), especially in patients without diabetes or heart failure (HF).
Conclusions:
- A gap exists in the implementation of guideline-recommended cardio-renoprotective therapies in primary care for CKD patients.
- Treatment patterns varied based on comorbidities, with lower uptake of RAASis and SGLT2is in patients without diabetes or HF.
- Clear recommendations are needed to optimize early cardio-renal protection in primary care settings.
Objectives:
To describe the clinical characteristics, comorbidity, and medical treatment in a primary care population with chronic kidney disease (CKD). Additionally, to investigate how primary care physicians (PCPs) diagnose, manage and treat impaired kidney function, including uptake of cardio-renoprotective renin-angiotensin-aldosterone system inhibitors (RAASis) and sodium glucose co-transporter 2 inhibitors (SGLT2is).
Design:
An observational study of CKD prevalence, treatment patterns and comorbidities in primary care based on patient record data combined with a questionnaire on diagnosis, management and treatment of impaired kidney function in a real-world, primary care setting.
Setting:
In all 128 primary care clinics in Denmark of 211 randomly invited and a quetionnaire completed by 125/128 participating PCPs.
Methods:
A computerized selection identified 12 random individuals with CKD per clinic with ≥ 2 measurements of eGFR < 60 mL/min/1.73 m2 or UACR > 30 mg/g within two years (N = 1 497). Pre-specified data collected from individual electronic health records included demographics, clinical variables, comorbidities, and relevant prescribed medications.
Results:
Of the CKD study population (N = 1 497), 80% had hypertension, 32% diabetes (DM), 13% heart failure (HF), 59% no DM/HF. ACEis/ARBs were prescribed to 65%, statins to 56%, SGTL2is to 14%, and MRAs to 8% of all individuals. Treatment patterns differed between individuals with varying comorbidities, e.g., ACEis/ARBs usage was higher in DM (76%) or HF (74%) vs. no DM/HF (58%), as was statin usage (76% in DM vs. 45% in no DM/HF). SGTL2i usage in no DM/HF was low. Most PCPs identified CKD using eGFR < 60 mL/min/1.73 m2 (62%) or UACR > 30 mg/g (58%) and 62% reported initiating treatment to retard kidney function decline.
Conclusions:
Despite good PCP awareness and wish to use relevant guidelines, a gap exists in implementation of cardio-renoprotective treatment, especially in individuals without DM/HF. This offers an opportunity for clear recommendations to PCPs to optimize early cardio-renal protection in individuals with CKD.
