Prevalence, risk factors and renoprotective treatment of chronic kidney disease among internal medicine outpatients at a Central European tertiary care centre: a cross-sectional study.

objectivesTo determine the prevalence of chronic kidney disease (CKD) in internal medicine outpatients in a Central European tertiary care setting, identify associated risk factors and assess use and potential impact of renoprotective therapies. We hypothesised that CKD is common, underdiagnosed and undertreated.

designCross-sectional observational study.

settingTertiary care outpatient clinics in Central Europe.

participants1933 adult outpatients at risk for CKD were screened; an expanded cohort of 2903 patients with available laboratory data was included for secondary analyses. Inclusion required assessment of estimated glomerular filtration rate (eGFR) and urine albumin-creatinine ratio (uACR) within the study period. Kidney transplant recipients were excluded. PRIMARY AND SECONDARY OUTCOME MEASURES: The primary outcome was CKD prevalence defined by eGFR and uACR per kidney disease improving global outcomes criteria. Secondary outcomes included detection of previously unrecognised CKD, associations with clinical risk factors and prescription rates of renoprotective therapies. CKD prevalence was also assessed using age-calibrated eGFR thresholds. An exploratory outcome was model-projected gain in dialysis-free time with treatment initiation.

resultsCKD prevalence was 32.5% (95% credible interval (CrI) 30.5 to 34.6) and remained high after age-calibrated eGFR adjustment. One new case was revealed for every 5.2 patients screened. CKD odds increased with age (per 25 years: OR 3.81, 95% CrI 3.09 to 4.67), non-renal transplantation (OR 4.38, 95% CrI 3.30 to 5.84), hypertension (OR 2.61, 95% CrI 1.96 to 3.54), heart failure or atrial fibrillation (OR 1.59, 95% CrI 1.29 to 1.96), type 1 (OR 1.97, 95% CrI 1.47 to 2.63) and type 2 diabetes (OR 1.46, 95% CrI 1.21 to 1.77), and atherosclerotic disease (OR 1.49, 95% CrI 1.20 to 1.82). Renoprotective therapy use was suboptimal (sodium-glucose co-transporter-2 inhibitors 42%, glucagon-like peptide-1 receptor agonists 41.7%, nonsteroidal mineralocorticoid receptor antagonists 6.7% of eligible patients). The model-projected gain in dialysis-free time by initiation of renoprotective treatment was estimated to be 11.13 months per CKDe patient on average.

conclusionsCKD is highly prevalent in tertiary care outpatients and efficiently detected through targeted screening. Suboptimal use of renoprotective therapies highlights a major treatment gap. Further research should address implementation strategies. TRIAL REGISTRATION NUMBER: NCT07153432.