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[InspeCKD - Analysis of the use of diagnostics in patients at high risk for chronic kidney disease in German general practitioner (GP) practices].
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- Author(s): Wanner C;Wanner C; Schaeffner E; Schaeffner E; Frese T; Frese T; Weber C; Weber C; Stahl P; Stahl P; Scherg F; Scherg F; Burckhardt F; Burckhardt F; Opfermann U; Opfermann U; Radowsky F; Radowsky F; Mader F; Mader F
- Source:
MMW Fortschritte der Medizin [MMW Fortschr Med] 2024 Apr; Vol. 166 (Suppl 4), pp. 9-17.- Publication Type:
English Abstract; Journal Article- Language:
German - Source:
- Additional Information
- Transliterated Title: InspeCKD - Analyse zur Nutzung von Labordiagnostik im Kontext der chronischen Nierenerkrankung : Daten von Risikopatientinnen und -patienten in deutschen Hausarztpraxen.
- Source: Publisher: Springer Country of Publication: Germany NLM ID: 100893959 Publication Model: Print Cited Medium: Internet ISSN: 1613-3560 (Electronic) Linking ISSN: 14383276 NLM ISO Abbreviation: MMW Fortschr Med Subsets: MEDLINE
- Publication Information: Publication: 2012- : Berlin : Springer
Original Publication: München : Urban & Vogel, [1999- - Subject Terms: Cardiovascular Diseases*/diagnosis ; Cardiovascular Diseases*/epidemiology ; General Practitioners* ; Renal Insufficiency, Chronic*/diagnosis ; Renal Insufficiency, Chronic*/epidemiology ; Hypertension*/diagnosis ; Hypertension*/epidemiology ; Diabetes Mellitus*/epidemiology; Adult ; Humans ; Retrospective Studies ; Cross-Sectional Studies ; Albuminuria/diagnosis ; Albuminuria/epidemiology ; Glomerular Filtration Rate
- Abstract: Background: Despite the high prevalence of chronic kidney disease (CKD) in Germany, only a small proportion of patients are currently diagnosed with CKD. Patients with hypertension, diabetes mellitus, and/or cardiovascular disease have a significantly increased risk of developing CKD and rapid disease progression and should therefore be screened and monitored in accordance with the guidelines.
Objectives: The aim of this retrospective, cross-sectional study was to gain insights into appropriate diagnosis of patients at risk for CKD in German general practitioner practices.
Method: For the analysis of the use of CKD-relevant diagnostics, electronic patient records from German general practitioner practices were analyzed. Adults with hypertension and/or diabetes mellitus and/or cardiovascular disease with a documented observation period of at least one year were included in the study.
Results: Data from a total of 448,837 patients from 1244 general practitioner practices were analyzed. 75.8% of patients had hypertension, 35.1% had cardiovascular disease, and 32.4% had diabetes mellitus. During a mean observation period of 1.7 years, serum creatinine was assessed at least once in 45.5% of patients. A urine dipstick test for albuminuria was performed in 7.9% of patients and in 0.4% of patients, urine albumin-to-creatine ratio (UACR) was measured. Laboratory diagnostics were initiated a little more frequently in high-risk patients compared to the overall cohort.
Conclusions: The study highlights that despite known risk factors, guideline compliant CKD screening is rarely performed in German general practitioner practices, which implicates the need to increase the awareness of early diagnosis of CKD in patients at risk.
(© 2024. Springer Medizin Verlag GmbH, ein Teil von Springer Nature.) - References: Gemeinsamer Bundesausschuss (G-BA). Beschluss des Gemeinsamen Bundesausschusses über die Veröffentlichung des Jahresberichts 2019 zur Qualität in der Dialyse, 20. November 2020. https://www.g-ba.de/downloads/39-261-4568/2020-11-20_QSD-RL_IQTIG-Jahresbericht-2019.pdf (zuletzt abgerufen am 14.12.2023).
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Girndt M et al. The prevalence of renal failure. Results from the German Health Interview and Examination Survey for Adults, 2008-2011 (DEGS1). Dtsch Arztebl Int 2016;113(6):85-91.
Brück K et al; European CKD Burden Consortium. CKD prevalence varies across the European general population. J Am Soc Nephrol 2016;27(7):2135-2147.
Stolpe S et al. High unawareness of chronic kidney disease in Germany. Int J Environ Res Public Health 2021;18(22):11752.
Xie Y et al. Analysis of the Global Burden of Disease study highlights the global, regional, and national trends of chronic kidney disease epidemiology from 1990 to 2016. Kidney Int 2018;94(3):567-581.
Hill NR et al. Global prevalence of chronic kidney disease - a systematic review and meta-analysis. PLoS One 2016;11(7):e0158765.
United States Renal Data System (USRDS): The USRDS Interactive Annual Data Report. Chapter 1: Chronic Kidney Disease. https://usrds-adr.niddk.nih.gov/2023/chronic-kidney-disease (zuletzt abgerufen am 14.12.2023).
Chen J et al; CRIC Investigators. Coronary artery calcification and risk of cardiovascular disease and death among patients with chronic kidney disease. JAMA Cardiol 2017;2(6):635-643.
Interdisziplinäre S2k-Leitlinie - Rationelle Labordiagnostik zur Abklärung Akuter Nierenschädigungen und Progredienter Nierenerkrankungen - Langfassung. 2021. 1. Auflage. https://register.awmf.org/assets/guidelines/115-001l_S2k_Rationelle_Labordiagnostik_Abkl%C3%A4rung_Nierensch%C3%A4digungen_Nierenerkrankungen_2021-09_01.pdf (zuletzt abgerufen am 14.12.2023).
Group, K.D.I.G.O.K.C.W., KDIGO 2012 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease. Kidney International Supplements, 2013. 3. https://kdigo.org/wp-content/uploads/2017/02/KDIGO_2012_CKD_GL.pdf (zuletzt abgerufen am 14.12.2023).
Tuttle KR et al. Clinical characteristics of and risk factors for chronic kidney disease among adults and children: an analysis of the CURE-CKD Registry. JAMA Netw Open 2019;2(12):e1918169.
Tangri N et al. Prevalence of undiagnosed stage 3 chronic kidney disease in France, Germany, Italy, Japan and the USA: results from the multinational observational REVEAL-CKD study. BMJ Open 2023;13(5):e067386.
Chen TK et al. Chronic kidney disease diagnosis and management: a review. JAMA 2019;322(13):1294-1304.
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Kidney disease: improving global outcomes (KDIGO) CKD work group. KDGIGO 2012 clinical practice guideline for the evaluation and management of chronic kidney disease. Kidney Int Suppl 2013;3:1-150 https://kdigo.org/wp-content/uploads/2017/02/KDIGO_2012_CKD_GL.pdf (zuletzt abgerufen am 14.12.2023).
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Park JI et al. Comparison of urine dipstick and albumin:creatinine ratio for chronic kidney disease screening: A population-based study. PLoS One 2017;12(2):e0171106.
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Alfego D et al. Chronic kidney disease testing among at-risk adults in the U.S. remains low: Real-World Evidence From a National Laboratory Database. Diabetes Care 2021;44(9):2025-2032. - Contributed Indexing: Keywords: CKD; Chronic kidney disease; diagnosis; primary care; screening
Local Abstract: [Publisher, German] Hintergrund: Die Diagnose „chronische Nierenerkrankung“ (CKD) wird in Deutschland trotz einer hohen Prävalenz nur bei einem geringen Anteil der Patientinnen und Patienten frühzeitig gestellt. Insbesondere Personen mit Bluthochdruck, Diabetes mellitus und/oder kardiovaskulären Erkrankungen haben ein deutlich erhöhtes Erkrankungs- und Progressionsrisiko und sollten daher leitliniengerecht gescreent und überwacht werden.Fragestellung: Ziel dieser retrospektiven Querschnittsstudie war es, ein besseres Verständnis über die CKD-spezifische Labordiagnostik von Risikopatienten in deutschen Hausarztpraxen zu gewinnen. [Publisher, German] Für die Analyse wurden anonymisierte elektronische Patientendatensätze aus deutschen Hausarztpraxen ausgewertet. Eingeschlossen wurden Erwachsene mit Bluthochdruck und/oder Diabetes mellitus und/oder kardiovaskulären Erkrankungen mit einer Beobachtungsdauer von mindestens einem Jahr.Ergebnisse: Es wurden Daten von insgesamt 448.837 Patienten aus 1.244 Hausarztpraxen analysiert. 75,8% der Patienten litten an Bluthochdruck, 35,1% an einer kardiovaskulären Erkrankung und 32,4% an Diabetes mellitus. Im Beobachtungszeitraum von durchschnittlich 1,7 Jahren erhielten 45,5% der Risikopatienten mindestens eine Serumkreatininbestimmung, 7,9% einen Harnstreifentest zum Nachweis einer Albuminurie und 0,4% mindestens eine Bestimmung der Urin-Albumin-Kreatinin-Ratio (UACR). Bei Hochrisikopatienten wurde die genannte Labordiagnostik etwas häufiger veranlasst.Schlussfolgerungen: Die Ergebnisse der InspeCKD-Studie zeigen, dass trotz bekannter Risikofaktoren für eine CKD eine leitliniengerechte Labordiagnostik in deutschen Hausarztpraxen nicht ausreichend durchgeführt wird und umfassender Aufklärungsbedarf in Bezug auf die Früherkennung der CKD bei Risikopatientinnen und -patienten besteht.Schlüsselwörter: Chronische Nierenerkrankung, CKD, Hausarzt, (Labor-)Diagnostik, ScreeningEingereicht am 05.02.2024 - akzeptiert am 16.02.2024. - Publication Date: Date Created: 20240404 Date Completed: 20240408 Latest Revision: 20240408
- Publication Date: 20240408
- Accession Number: 10.1007/s15006-024-3684-y
- Accession Number: 38575833
- Transliterated Title:
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