A decade after the KDOQI CKD guidelines: impact on research

Guidelines, policies, and barriers to kidney care: findings from a global survey

An international survey led by the International Society of Nephrology in 2016 assessed the current capacity of kidney care worldwide. To better understand how governance and leadership guide kidney care, items pertinent to government priority, advocacy, and guidelines, among others, were examined. Of the 116 responding countries, 36% (n = 42) reported CKD as a government health care priority, which was associated with having an advocacy group (χ2 = 11.57; P = 0.001). Nearly one-half (42%; 49 of 116) of countries reported an advocacy group for CKD, compared with only 19% (21 of 112) for AKI. Over one-half (59%; 68 of 116) of countries had a noncommunicable disease strategy. Similarly, 44% (48 of 109), 55% (57 of 104), and 47% (47 of 101) of countries had a strategy for nondialysis CKD, chronic dialysis, and kidney transplantation, respectively. Nearly one-half (49%; 57 of 116) reported a strategy for AKI. Most countries (79%; 92 of 116) had access to CKD guidelines and just over one-half (53%; 61 of 116) reported guidelines for AKI. Awareness and adoption of guidelines were low among nonnephrologist physicians. Identified barriers to kidney care were factors related to patients, such as knowledge and attitude (91%; 100 of 110), physicians (84%; 92 of 110), and geography (74%; 81 of 110). Specific to renal replacement therapy, patients and geography were similarly identified as a barrier in 78% (90 of 116) and 71% (82 of 116) of countries, respectively, with the addition of nephrologists (72%; 83 of 116) and the health care system (73%; 85 of 116). These findings inform how kidney care is currently governed globally. Ensuring that guidelines are feasible and distributed appropriately is important to enhancing their adoption, particularly in primary care. Furthermore, increasing advocacy and government priority, especially for AKI, may increase awareness and strategies to better guide kidney care.

Prevalence, awareness and treatment of chronic kidney disease among middle-aged and elderly: The China Health and Retirement Longitudinal Study

AIM

To provide reliable estimates of the prevalence, awareness, and treatment of chronic kidney disease (CKD), and their distribution and related influencing factors in middle-aged and elderly population in China.

METHODS

A cross-sessional survey called the China Health and Retirement Longitudinal Study (CHARLS) was conducted in 2011-2012 in Chinese people aged 45 years or older. This was to evaluate the prevalence of CKD, disease awareness compared to other chronic diseases in the population, and whether they were being treated for their CKD. Estimated GFR (eGFR) was calculated using the Chronic Kidney Disease Epidemiology Collaboration eGFR creatinine-cystatin C (eGFRcreat-cys) equation. CKD was defined as eGFR less than 60 mL/min per 1.73 m(2) . Multivariable logistic regressions were used to estimate odds ratios (ORs) for the risk factors.

RESULTS

The overall prevalence of CKD was 11.5% (95%CI: 10.1% ∼ 12.8%). It was higher in urban than rural population (13.0% vs 10.0%, P < 0.05). Among all patients with CKD, only 8.7% were aware of the diagnosis. 4.9% of the patients were receiving treatment. The proportion of those aware of their condition and those who were treated decreased with age in both sexes. Of those aware (8.9%), 55.9% were treated. 31.4% of the treated patients took Chinese traditional medicine.

CONCLUSIONS

There is a surprising prevalence of CKD in the Chinese middle-aged and elderly population, with disproportionately low awareness and treatment. A comprehensive strategy toward prevention, screening, treatment and control of CKD is needed to slow the epidemic of CKD.

Updated guidelines for managing chronic kidney disease

Chronic kidney disease (CKD) is the most costly disease covered by Medicare, and two common causes of CKD, diabetes and hypertension, are increasing worldwide. More than 60% of Americans will develop CKD in their lifetimes. This article reviews updated guidelines for managing CKD in primary care.