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Differences in chronic kidney disease management based on identification and diagnosis in a population-based
Michael Olszewski1,2, Karl Bjurström3, Markus Lingman3,4,5
1Department of Research and Development, Region Halland, Halmstad, Sweden.
Insights
Most chronic kidney disease (CKD) patients remain undiagnosed, leading to suboptimal care. Diagnosed CKD patients receive better management, highlighting the need for improved CKD identification strategies.
Area of Science:
- Nephrology
- Public Health
- Epidemiology
Background:
- Chronic kidney disease (CKD) affects a significant portion of the adult population, often progressing undetected.
- Late diagnosis of CKD leads to delayed interventions and poorer health outcomes.
Purpose of the Study:
- To compare the prevalence, clinical management, healthcare utilization, and mortality rates among diagnosed, proxy-diagnosed, and undiagnosed CKD patients.
- To identify disparities in care and outcomes based on CKD diagnostic status.
Main Methods:
- Retrospective observational study utilizing healthcare data from Region Halland for adults meeting KDIGO CKD criteria in 2019.
- Patients were categorized into diagnosed, proxy-diagnosed (CKD-related diagnoses), and undiagnosed (meeting criteria without ICD diagnosis) groups.
Main Results:
- 61% of 20,488 CKD patients were undiagnosed, 21% diagnosed, and 18% proxy-diagnosed.
- Diagnosed CKD patients showed higher rates of blood pressure follow-up (88%), eGFR testing (73%), UACR testing (50%), and RAS inhibitor prescription (51%) compared to other groups.
- Higher adjusted hospitalization risk (2.71) and all-cause mortality hazard ratio (2.22) were observed in diagnosed CKD patients versus undiagnosed.
Conclusions:
- CKD diagnosis is associated with more complex comorbidities, advanced disease, and frequent hospitalizations, leading to better follow-up care.
- Proxy-diagnosed CKD is prevalent and linked to suboptimal management, underscoring the need for accurate CKD identification.
- Consistent and precise CKD identification is crucial for enhancing patient outcomes and optimizing healthcare delivery.
Background:
Chronic kidney disease (CKD) affects 6-10% of adults and often remains undiagnosed until advanced stages, leading to inadequate management. This study compared diagnosed, proxy-diagnosed, and undiagnosed CKD patients regarding prevalence, clinical assessment, nephroprotective treatment, healthcare utilization, and mortality.
Methods:
This retrospective observational study analyzed Region Halland's healthcare data for adults meeting KDIGO CKD-confirmed criteria for the year 2019. Patients were categorized as diagnosed CKD (ICD-coded), proxy-diagnosed CKD (CKD-related diagnoses), or undiagnosed CKD (meeting CKD criteria without an ICD CKD diagnosis).
Results:
Of 20,488 CKD patients, 21% had diagnosed CKD, 18% proxy-diagnosed CKD, and 61% undiagnosed CKD. Mean ages were 76.4, 62.4, and 81.8 years, respectively (p < 0.001). Blood pressure follow-up was carried out in diagnosed CKD (88%) versus 67% and 80% in the proxy-diagnosed and undiagnosed groups. eGFR was tested in 66% overall (73% diagnosed, 53% proxy-diagnosed, 66% undiagnosed), while urine albumin-to-creatinine ratio (UACR) testing was performed in 27% overall (50%, 20%, and 21%, respectively). Renin-angiotensin system inhibitors were prescribed to 45% overall (51%, 28%, and 47%, respectively). The adjusted hospitalization risk was 2.71 (CI: 2.59-2.84) in diagnosed CKD and 1.38 (CI: 1.31-1.46) in proxy-diagnosed CKD. Adjusted all-cause mortality hazard ratios were 2.22 (CI: 1.95-2.52) and 1.31 (CI: 1.08-1.60), respectively. Stratified sensitivity analyses by CKD stage confirmed these associations, though the strength varied.
Conclusions:
Patients with complex comorbidities, more advanced CKD, and frequent hospitalizations are more likely to be diagnosed with CKD and receive better follow-up care. Proxy-diagnosed CKD was common and associated with suboptimal management. These findings emphasize the need for consistent and accurate CKD identification to improve outcomes and optimize care.
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