--- title: "Prevalence, risk factors, and renoprotective treatment gaps in chronic kidney disease among tertia" id: "bmj-open-9-prevalence-risk-factors-and-renoprotective-treatment-of-chronic-kidney-disease" canonical_url: "https://medichelpline.com/clinical-feed/bmj-open-9-prevalence-risk-factors-and-renoprotective-treatment-of-chronic-kidney-disease" content_type: "clinical_feed_article" specialty: "Nephrology" source_name: "BMJ Open" source_url: "http://bmjopen.bmj.com/cgi/content/short/16/10/e121190?rss=1" published_at: "2026-10-06T11:59:03.000Z" evidence_level: "Journal Feed" license: "CC-BY-NC-4.0 / Informational Use" --- # Prevalence, risk factors, and renoprotective treatment gaps in chronic kidney disease among tertia ## Provenance & Clinical Metadata - **Canonical URL:** https://medichelpline.com/clinical-feed/bmj-open-9-prevalence-risk-factors-and-renoprotective-treatment-of-chronic-kidney-disease - **Specialty:** [Nephrology](https://medichelpline.com/clinical-feed/nephrology.md) - **Primary Source:** BMJ Open - **Source URL:** [Original Journal Publication](http://bmjopen.bmj.com/cgi/content/short/16/10/e121190?rss=1) - **Published At:** 2026-10-06T11:59:03.000Z - **Evidence Rating:** Journal Feed ## Executive GIST (TL;DR) - This cross-sectional study screened adult internal medicine outpatients at a Central European tertiary care centre to assess **chronic kidney disease (CKD)** prevalence, risk factors, and use of renoprotective therapies. - Primary cohort: 1,933 at-risk outpatients screened with available eGFR and uACR; expanded cohort for secondary analyses included 2,903 patients with laboratory data. Kidney transplant recipients were excluded. - CKD was defined using estimated glomerular filtration rate (**eGFR**) and urine albumin-creatinine ratio (**uACR**) per KDIGO criteria. An age-calibrated eGFR analysis was also performed. - Overall CKD prevalence was 32.5% (95% credible interval 30.5–34.6) and remained high after age-calibrated eGFR adjustment. - Screening efficiency: one previously unrecognised CKD case identified per 5.2 patients screened, indicating targeted screening detects a substantial number of undiagnosed cases. - Independent factors associated with higher CKD odds included increased age (per 25 years: OR 3.81), prior non-renal transplantation (OR 4.38), hypertension (OR 2.61), heart failure or atrial fibrillation (OR 1.59), type 1 diabetes (OR 1.97), type 2 diabetes (OR 1.46), and atherosclerotic disease (OR 1.49). - Use of guideline-relevant renoprotective agents was suboptimal among eligible patients: **SGLT2 inhibitors** 42%, **GLP-1 receptor agonists** 41.7%, and nonsteroidal mineralocorticoid receptor antagonists 6.7%. - An exploratory model estimated that initiation of renoprotective therapy could yield an average projected gain of 11.13 months of dialysis-free time per patient with CKD. - The study concludes CKD is common in tertiary outpatients, is efficiently identified by targeted screening, and there is a major treatment gap in renoprotective therapy use; further work should focus on implementation strategies. ## Clinical Analysis & Structured Key Points Objectives To 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. Design Cross-sectional observational study. Setting Tertiary care outpatient clinics in Central Europe. Participants 1933 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. Results CKD 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. Conclusions CKD 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. 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