Prevalence, awareness, and management of CKD and cardiovascular risk factors in publicly funded health care

Abstract

Background and objectives: It is uncertain how many patients with CKD and cardiovascular risk factors in publicly funded universal health care systems are aware of their disease and how to achieve their treatment targets.

Design, setting, participants, & measurements: The CARTaGENE study evaluated BP, lipid, and diabetes profiles as well as corresponding treatments in 20,004 random individuals between 40 and 69 years of age. Participants had free access to health care and were recruited from four regions within the province of Quebec, Canada in 2009 and 2010.

Results: CKD (Chronic Kidney Disease Epidemiology Collaboration equation; <60 ml/min per 1.73 m(2)) was present in 4.0% of the respondents, and hypertension, diabetes, and hypercholesterolemia were reported by 25%, 7.4%, and 28% of participants, respectively. Self-awareness was low: 8% for CKD, 73% for diabetes, and 45% for hypercholesterolemia. Overall, 31% of patients with hypertension did not meet BP goals, and many received fewer antihypertensive drugs than appropriately controlled individuals; 41% of patients with diabetes failed to meet treatment targets. Among those patients with a moderate or high Framingham risk score, 53% of patients had LDL levels above the recommended levels, and many patients were not receiving a statin. Physician checkups were not associated with greater awareness but did increase the achievement of targets.

Conclusion: In this population with access to publicly funded health care, CKD and cardiovascular risk factors are common, and self-awareness of these conditions is low. Recommended targets were frequently not achieved, and treatments were less intensive in those patients who failed to reach goals. New strategies to enhance public awareness and reach guideline targets should be developed.

Figure 1.

Classes of antihypersensive drugs used in individuals with self-reported hypertension with and without CKD. BB, β-blocker; CCB, calcium channel blocker; RASB, renin angiotensin system blockade using either angiotensin-converting enzyme inhibitors or angiotensin receptor blockers.

Figure 2.

Number of antihypertensive drugs used in individuals with self-reported hypertension. Target BP is ≤140/90 or ≤130/80 mmHg in individuals with diabetes or CKD. Individuals not on target used fewer drugs (P<0.001).

Figure 3.

Hemoglobin A1c (HbA1c) values in individuals with self-reported diabetes according to therapy and CKD. Participants with self-reported diabetes (n=1492) are categorized according to treatment regimens: diet only, oral hypoglycemic agents, or treatment with insulin. CKD was defined by eGFR<60 ml/min per 1.73 m² estimated by the Chronic Kidney Disease Epidemiology Collaboration equation.

Figure 4.

Statin therapy in individuals with self-reported hypercholesterolemia. Fasting LDL targets are according to the Adult Treatment Panel III cholesterol recommendations. Using the Framingham risk score, individuals at low risk have 10% or less CHD risk at 10 years, individuals at intermediate risk have 10%–20% CHD risk at 10 years, and individuals at high risk have 20% or more CHD risk at 10 years. Individuals on target used a statin significantly more often (P<0.001).