[Detection and classification of chronic kidney disease in Primary Care and importance of albuminuria]

Abstract

Introduction: Chronic kidney disease (CKD) is a public health problem, and Primary Care (PC) plays a key role in its detection and classification based on estimated glomerular filtration rate (eGFR), as well as the level of albuminuria for its proper management. The aim of this study was to analyse the prevalence and classification of CKD in patients attended in PC.

Material and methods: An analysis was made of CKD prevalence and classification according to the Kidney Disease-Improving Global Outcomes guidelines in PC patients. All biochemical analyses requested from PC on patients 18 years and older over a 5-year period were collected. When several analyses were available on a patient, the biochemistry result with the best eGFR was selected.

Results: Between 2010 and 2014, PC requested 304,523 biochemical analyses on 97,470 adult patients, with a mean age of 53.4±19.4 years, of which 57.2% were women. CKD prevalence was 7.6%. Urine protein results were present in only 16.6% of analyses, and only 15.2% patients had a urine protein result. Urine albumin was measured 15.4% of biochemical controls with eGFR≥60mL/min/1.73m², in 27.1% of patients with eGFR between 30-59mL/min/1.73m² (G3a-3b stages), and in 23.4% of patients with eGFR<30mL/min/1.73m² (G4-5 stages). Urine albumin was tested in 37.7% of diabetics and in 23.5% of impaired fasting glucose.

Conclusions: Requests for the measurement of urine proteins/albumin in PC patients are low, leading to only one in 6 PC patients being classified correctly. The measurement of urine proteins/albumin is higher in CKD and diabetic patients.

Keywords: Albuminuria; Atención Primaria; Chronic kidney disease; Clasificación; Classification; Diabetes mellitus; Enfermedad renal crónica; Primary Care.