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. 2016 Dec;31(12):2086-2094.
doi: 10.1093/ndt/gfw354. Epub 2016 Oct 13.

Prevalence and recognition of chronic kidney disease in Stockholm healthcare

Alessandro Gasparini  1 , Marie Evans  1 , Josef Coresh  2 , Morgan E Grams  2   3 , Olof Norin  4 , Abdul R Qureshi  1 , Björn Runesson  1 , Peter Barany  1 , Johan Ärnlöv  5   6 , Tomas Jernberg  7   8 , Björn Wettermark  9   10 , Carl G Elinder  1   9 , Juan-Jesüs Carrero  1   11
Affiliations

Prevalence and recognition of chronic kidney disease in Stockholm healthcare

Alessandro Gasparini et al. Nephrol Dial Transplant. 2016 Dec.

Abstract

Background: Chronic kidney disease (CKD) is common, but the frequency of albuminuria testing and referral to nephrology care has been difficult to measure. We here characterize CKD prevalence and recognition in a complete healthcare utilization cohort of the Stockholm region, in Sweden.

Methods: We included all adult individuals (n = 1 128 058) with at least one outpatient measurement of IDMS-calibrated serum creatinine during 2006-11. Estimated glomerular filtration rate (eGFR) was calculated via the CKD-EPI equation and CKD was solely defined as eGFR <60 mL/min/1.73 m2. We also assessed the performance of diagnostic testing (albuminuria), nephrology consultations, and utilization of ICD-10 diagnoses.

Results: A total of 68 894 individuals had CKD, with a crude CKD prevalence of 6.11% [95% confidence interval (CI): 6.07-6.16%] and a prevalence standardized to the European population of 5.38% (5.33-5.42%). CKD was more prevalent among the elderly (28% prevalence >75 years old), women (6.85 versus 5.24% in men), and individuals with diabetes (17%), hypertension (17%) or cardiovascular disease (31%). The frequency of albuminuria monitoring was low, with 38% of diabetics and 27% of CKD individuals undergoing albuminuria testing over 2 years. Twenty-three per cent of the 16 383 individuals satisfying selected KDIGO criteria for nephrology referral visited a nephrologist. Twelve per cent of CKD patients carried an ICD-10 diagnostic code of CKD.

Conclusions: An estimated 6% of the adult Stockholm population accessing healthcare has CKD, but the frequency of albuminuria testing, nephrology consultations and registration of CKD diagnoses was suboptimal despite universal care. Improving provider awareness and treatment of CKD could have a significant public health impact.

Keywords: chronic renal failure; creatinine; nephrology; public health; referral.

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Figures

FIGURE 1:
FIGURE 1:
Prevalence of CKD in the region of Stockholm, stratified by age, gender and comorbidities.
FIGURE 2:
FIGURE 2:
Prevalence of CKD, stratified by comorbid combinations and age categories. DM, diabetes mellitus; HT, hypertension.
FIGURE 3:
FIGURE 3:
Proportions of deaths within 12 months, by eGFR group (G3+ defines CKD) and presence of nephrology referral/physician diagnosis. Also shown are the number and proportion of individuals in each category.
See this image and copyright information in PMC

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