[Prevalence of chronic renal failure in primary care]

Prevalence of chronic kidney disease and associated factors in the Spanish population attended in primary care: Results of the IBERICAN study

OBJECTIVES

To determine the prevalence of chronic kidney disease (CKD) and the factors associated with impaired renal function in the population attended in primary care (PC).

PATIENTS AND METHOD

Cross-sectional and multicentre study carried out in the baseline patients of the IBERICAN study (Identificación de la poBlación Española de RIesgo CArdiovascular y reNal). CKD was considered with an estimated glomerular filtration (eGF) <60ml/min/1.73 m² or elevated albuminuria (≥ 30mg/g). According to the eGF, the CKD was classified in six stages (1, 2, 3a, 3b, 4 and 5) and according to albuminuria in three stages (A1 or normal / slightly increased, A2 or moderately increased and A3 or severely increased). The clinical characteristics and the relationship of CKD with the main cardiovascular risk factors (CVRF) and other variables of interest were analysed using unconditional logistic regression.

RESULTS

7,895 patients were included (mean age 57.9±14.8 years; 54.5% women). 14.4% (95% CI: 13.6-15.1) had CKD; 16.1% (95% CI: 14.9-17.3) in men and 12.9% (95% CI: 11.9-14.0) in women. A continuous increase of the prevalence was observed with age (24.8% in≥65 years) and with CVFR aggregation. The variables that were most associated with the probability of suffering CKD were left ventricular hypertrophy (OR: 1.95; p <.001), diabetes (OR: 1.58; P<.001) and hypertension (OR: 1.56; P<.001).

CONCLUSIONS

Fourteen out of every 100 patients included in the IBERICAN study have CKD. The prevalence of CKD affects a quarter of patients ≥ 65 years and increases exponentially with the aggregation of FRCV.

The profile of patients with chronic kidney disease who regularly present at an Australian general practice

BACKGROUND

Chronic kidney disease (CKD) is a common, serious and mostly asymptomatic condition that places considerable burden on the Australian healthcare system. Yet there is limited information on the patients with CKD who present to Australian primary care services, which represent the gateway to specialized care.

METHODS

Data pertaining to 31,897 patients who presented to a general practice in Western Australia, from 1 January 2013 to 30 June 2014 (inclusive), were extracted for review. Data included attendance records, comorbidities, diagnoses, and demographic details. Binary logistic regression was used to compare patients diagnosed with CKD by the consulting general practitioner with those without this diagnosis.

RESULTS

Of the 8629 patients who regularly attended the practice, 184 (2%) were diagnosed with CKD (mean age: 77.7 years; male: 57.1%). The stage of CKD was recorded in only 8.4% of cases. Patients with CKD averaged 11 more consultations in the past 18 months (mean difference 10.8, 95% CI [9.3, 12.3], p < .001). They were also more likely to: be male; be ex-smokers; be widowed; and to have a carer. Their most common comorbidities included acute infections, cerebrovascular or ischemic heart disease, osteopenia or osteoporosis, and cancer; 8.7% had died within the previous year.

CONCLUSIONS

Despite the prevalence of CKD, only one in five cases were recorded within this large practice. This reveals lost opportunities to monitor and manage patients with this chronic and common disease. Although this represents an important finding, this study is limited by the reliance on practice records, some of which were incomplete. Nevertheless, this study reveals two key findings. First, this disease is under-diagnosed and/or under-recorded. Second, patients with CKD have other, potentially unrelated, problems that may warrant attention.

[Prevalence of hidden renal failure calculated through formulas on the degree of renal function in hypertense patients over 60 referred to out-patients for blood pressure monitoring]

OBJECTIVES

To validate the Cockroft-Gault and the abbreviated Modification of Diet in Renal Disease (MDRD) formulas in a hypertense population aged over 60 and with blood pressure monitored in out-patients. To evaluate the prevalence of various stages of hidden chronic kidney disease in this population.

DESIGN

Descriptive study of validation of diagnostic tests.

SETTING

Urban primary care centre.

PARTICIPANTS

A total of 113 patients over 60 (53.8% female) with hypertension and no history of chronic kidney disease, on whom blood pressure could be monitored in a 24-hour session.

MAIN MEASUREMENTS

Calculation of the glomerular filtration rate. Validity parameters of diagnostic tests.

RESULTS

Renal clearance estimated in the Cockroft-Gault and MDRD equations was similar (77.9 mL/min and 76.9 mL/min, respectively). There was 37.3% prevalence of chronic kidney disease, using the Cockroft-Gault equation; and 27.0%, using the MDRD. The degree of agreement between the two equations was excellent in classifying patients with stage-2 chronic kidney disease (kappa index =0.9) and it was acceptable for stage-3 (kappa index =0.5). In both equations, validity indexes were acceptable for the presence of microalbuminuria as a manifestation of renal damage.

CONCLUSIONS

There is a high prevalence of hidden chronic kidney disease in the hypertense population over 60 years old. Glomerular filtration should be determined systematically in these patients, even when their plasma creatinine figures are normal.

[Prevalence of "hidden" renal failure in the population suffering from type-2 diabetes]

OBJECTIVE

To determine the prevalence of renal failure (RF) in type-2 diabetics and to compare two criteria of definition: that based on the calculation of glomerular filtration by the Cockcroft-Gault formula corrected for body surface area and that based on serous creatinine.

DESIGN

Cross-sectional, descriptive study.

SETTING

El Cristo Health Centre, Oviedo, north of Spain.

PARTICIPANTS

All patients in the catchment area diagnosed with type-2 diabetes.

METHOD

Demographic, clinical, risk factor, and cardiovascular pathology details were gathered. Renal failure was diagnosed on figures of plasma creatinine >=1.3 mg/dL in women and >=1.4 mg/dL in men, and glomerular filtration (GF) calculated by means of the Cockcroft-Gault formula: moderate GF, 60-30 mL/min/1.73 m2; severe GF, 29-15 mL/min/1.73 m2, and terminal GF: <15 mL/min/1.73 m2.

RESULTS

499 patients were included. 52.3% were women, aged 69.7+/-10.4 years old. Prevalence of RF by serous creatinine was 12%; and by the Cockcroft-Gault formula, 40.5%. Patients with lower glomerular filtration and normal creatinine were older (75.5+/-7.9 vs 65.4+/-9.8; P<.001), mainly female (76.3% vs 41.7%; P<.001), had lower BMI (27.3+/-3.7 vs 30.9+/-4.4) and had worse glucaemia control (HbA1c 7.1+/-1.8% vs 6.9+/-1.9%; P=.007) and higher indices of cardiac failure (6.4% vs 2.1%; 95% CI, 1.1-8.8; P=.02) than patients with normal glomerular filtration and creatinine.

CONCLUSION

Calculation of glomerular filtration by the Cockcroft-Gault formula corrected for body surface area revealed unknown renal failure in 1 in 3 type-2 diabetes patients.