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Patients with chronic kidney disease stage 3b: do general practitioners and nephrologists follow KDIGO guidelines?

Juliana Gazzi Macedo1, Alessandra Maciel Almeida2, Helady Sanders-Pinheiro3,4

  • 1Faculdade de Ciências Médicas de Minas Gerais, Belo Horizonte, MG, Brazil.

Jornal Brasileiro De Nefrologia
|April 17, 2026
PubMed

Insights

Patients with chronic kidney disease (CKD) stage 3b had regular primary care but suboptimal lab monitoring, indicating a need for better guideline adherence and communication between general practitioners and nephrologists in Brazil.

Area of Science:

  • Nephrology
  • Public Health
  • Internal Medicine

Background:

  • Effective management of chronic kidney disease (CKD) is vital for preventing progression and complications.
  • Timely referral and coordinated care between primary care and nephrology are essential.

Purpose of the Study:

  • To characterize patients with CKD stage 3b referred to nephrology in Brazil's public health system (SUS).
  • To evaluate primary care and nephrology management, including adherence to guidelines.

Main Methods:

  • Retrospective cohort study of 211 patients with CKD stage 3b awaiting nephrology consultation (2018-2020).
  • Analysis of sociodemographic data, comorbidities, and adherence to Kidney Disease: Improving Global Outcomes (KDIGO) guidelines.
  • Comparison of laboratory test utilization before and after nephrology referral.

Main Results:

  • The cohort (mean age 74 years) had high rates of hypertension (76.0%) and diabetes (46.9%).
  • Primary care follow-up was adequate for about half of patients, but laboratory monitoring was suboptimal.
  • Post-nephrology referral, hemoglobin and potassium testing improved but remained incomplete.

Conclusions:

  • Regular follow-up for CKD stage 3b patients occurred, but adherence to KDIGO testing recommendations was low.
  • Improved communication and guideline implementation between primary care and nephrology are needed within the SUS.
  • Addressing care gaps is crucial for optimizing CKD management in Brazil.
Abstract

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