The study aimed to determine the prevalence of chronic kidney disease (CKD) among internal medicine outpatients at a Central European tertiary care centre, to identify clinical risk factors associated with CKD, and to assess the current use and potential impact of renoprotective therapies. The investigators hypothesised that CKD would be common, underdiagnosed, and undertreated.
This was a cross-sectional observational study conducted in tertiary care outpatient clinics in Central Europe. The report provides prevalence estimates, risk-factor associations, and treatment-use assessments based on laboratory and clinical data collected during the study period.
The primary screening cohort comprised 1,933 adult outpatients considered at risk for CKD who were screened during the study. For secondary analyses, an expanded cohort of 2,903 patients with available laboratory data (specifically eGFR and uACR) was included. Inclusion required assessment of estimated glomerular filtration rate (eGFR) and urine albumin-creatinine ratio (uACR) within the study period. Kidney transplant recipients were excluded from the analysis.
The primary outcome was CKD prevalence defined by eGFR and uACR according to Kidney Disease Improving Global Outcomes (KDIGO) criteria. Secondary outcomes included detection of previously unrecognised CKD, associations with clinical risk factors, and prescription rates of renoprotective therapies. CKD prevalence was also evaluated using age-calibrated eGFR thresholds. An exploratory outcome modelled the projected gain in dialysis-free time with initiation of renoprotective treatment.
CKD prevalence in the screened outpatient population was 32.5% with a 95% credible interval of 30.5 to 34.6. The prevalence remained high after applying age-calibrated eGFR adjustments, indicating that the observed burden of CKD was not fully explained by age-related declines in eGFR alone.
Targeted screening proved efficient: the study identified one new case of CKD for every 5.2 patients screened. This finding supports the utility of focused screening in a tertiary outpatient population to reveal undiagnosed CKD.
The analysis identified multiple clinical conditions associated with higher odds of CKD. Odds ratios (ORs) reported in the study were as follows:
These associations indicate that older age, cardiometabolic disease, and history of transplantation (non-renal) are important correlates of CKD in this outpatient population.
Renoprotective therapy use among eligible patients was reported to be suboptimal. Prescription rates provided in the source were:
The low uptake, particularly of nonsteroidal mineralocorticoid receptor antagonists, highlights an important treatment gap in this tertiary outpatient cohort.
An exploratory model estimated the potential benefit of initiating renoprotective treatment. The projected gain in dialysis-free time was estimated to be 11.13 months per CKD patient on average if renoprotective therapy were initiated according to the model assumptions reported in the study.
In this Central European tertiary care outpatient population, CKD was highly prevalent and could be efficiently detected through targeted screening using eGFR and uACR. Screening identified a substantial number of previously unrecognised cases (one new case per 5.2 screened). Multiple established risk factors were associated with higher CKD odds. Use of guideline-relevant renoprotective therapies was suboptimal, indicating a major treatment gap. The exploratory modelling suggested a meaningful potential gain in dialysis-free time with treatment initiation.
The authors conclude that further research should focus on implementation strategies to close the treatment gap and improve uptake of renoprotective therapies in similar outpatient settings.
The study is registered under trial number NCT07153432.