Chronic kidney disease in primary care in Germany

Gergei, Ingrid; Woitas, Rainer P.; Pieper, Lars; Wittchen, Hans‐Ulrich; Krämer, Bernhard K.; Wanner, Christoph; Mann, Johannes F.E.; Scharnagl, Hubert; März, Winfried; Mondorf, Ulrich F.

doi:10.1007/s10389-016-0773-0

Cited by 15 publications

(13 citation statements)

References 28 publications

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“…Although moderate and severe CKD is one of the EAS/ ESC very-high CV risk categories, it was not possible to obtain estimated glomerular filtration rate (eGFR) results in a manner permitting rigorous CKD identification. Within this study, CKD stages 3e4e5 were captured from ICD codes as a comorbidity, and 3.7% of patients were observed to have CKD stage 3e4e5; however, in a recent study among a similar population of patients, the prevalence of CKD was estimated at almost 30% [25]. The lower number of patients observed to have CKD stage 3e4e5 within this study is likely to be underestimated due to missing coding of CKD by GPs.…”

Section: Discussionmentioning

confidence: 67%

Utilization of lipid-modifying therapy and low-density lipoprotein cholesterol goal attainment in patients at high and very-high cardiovascular risk: Real-world evidence from Germany

et al. 2018

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Section: Discussionmentioning

confidence: 67%

Utilization of lipid-modifying therapy and low-density lipoprotein cholesterol goal attainment in patients at high and very-high cardiovascular risk: Real-world evidence from Germany

et al. 2018

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“…In 2009, in a report on the prevalence of patients with chronic diseases in general practice, the authoring physicians did not select CKD as one of 20 relevant diseases and conditions [24], although CKD prevalence in this setting is estimated to be about 30% [25].…”

Section: Unawareness In Patients Physicians and Publicmentioning

confidence: 99%

High Unawareness of Chronic Kidney Disease in Germany

Stolpe

Kowall

Scholz

et al. 2021

IJERPH

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Chronic kidney disease (CKD) is associated with an increased risk for cardiovascular events, hospitalizations, end stage renal disease and mortality. Main risk factors for CKD are diabetes, hypertension, and older age. Although CKD prevalence is about 10%, awareness for CKD is generally low in patients and physicians, hindering early diagnosis and treatment. We analyzed baseline data of 3305 participants with CKD Stages 1–4 from German cohorts and registries collected in 2010. Prevalence of CKD unawareness and prevalence ratios (PR) (each with 95%-confidence intervals) were estimated in categories of age, sex, CKD stages, BMI, hypertension, diabetes and other relevant comorbidities. We used a log-binomial regression model to estimate the PR for CKD unawareness for females compared to males adjusting for CKD stage and CKD risk factors. CKD unawareness was high, reaching 71% (68–73%) in CKD 3a, 49% (45–54%) in CKD 3b and still 30% (24–36%) in CKD4. Prevalence of hypertension, diabetes or cardiovascular comorbidities was not associated with lower CKD unawareness. Independent of CKD stage and other risk factors unawareness was higher in female patients (PR = 1.06 (1.01; 1.10)). Even in patients with CKD related comorbidities, CKD unawareness was high. Female sex was strongly associated with CKD unawareness. Guideline oriented treatment of patients at higher risk for CKD could increase CKD awareness. Patient–physician communication about CKD might be amendable.

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“…CKD knows a long asymptomatic course during the early stages G1 to G3 and symptoms are usually not apparent until the later stages G4 to G5 (Table ) (KDIGO, ). End‐stage renal disease (ESRD) or kidney failure is the most serious outcome of CKD and although only 1% of persons with CKD will need dialysis or kidney transplantation, this outcome reduces lifespan significantly and causes high cost in the healthcare system (Bolignano, Mattace‐Raso, Sijbrands, & Zoccali, ; Gergei et al, ; KDIGO, ; Levey et al, ; Stevens, Viswanathan, & Weiner, ). CKD has a variable prevalence worldwide (Table ) and main risk factors for ESRD in industrialised countries are diabetes and hypertension Aitken et al, ; Australian Institute of Health & Welfare, 2018; Brück et al, ; Hill et al, ; KDIGO, ; Saran et al,).…”

Section: Introductionmentioning

confidence: 99%

Nephrologists’ perspectives on ambulatory care of patients with non‐dialysis chronic kidney disease ‐ A qualitative study

Haase

Stracke²,

Chenot

et al. 2019

Health Soc Care Community

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Little is known on the perspectives of nephrologists on managing non-dialysis patients with chronic kidney disease (CKD). The purpose of this qualitative study was to explore the experiences and perspectives of nephrologists regarding the interface with general practitioners (GP) and GPs' management of patients with non-dialysis CKD, so that barriers to cooperation and need for improved management can be identified. Twenty semi-structured interviews were conducted for this qualitative study. The interviews were audio-recorded and coded to be analysed. The concept of knowledge systems served as a sensitising concept. Optimising underlying diseases, medication adaptation and patient awareness of CKD were regarded as the most important treatment measures in CKD management. Differing views exist on who should be responsible for lifestyle interventions, patient education and timing of referral. Nephrologists generally preferred the referral of patients with high progression risk and co-treatment models in which daily care was performed by GP, but some preferred referral of all patients with early CKD and some nephrologists stated that patient care should be in the hands of nephrologists entirely in case of CKD. Doctorpatient communication predominantly remained within the medical-scientific knowledge system whereas patients' everyday knowledge systems were rarely considered. While stressing optimisation of laboratory values, diabetes and hypertension, patients' perspectives and shared decision-making to identify and prioritise patients' individual health goals were rarely considered by nephrologists. Instead, most nephrologists regarded educating patients and GPs as an important part of their professional role. Defining the interface between GPs and nephrologists, with specific recommendations on when to refer and which tasks each professional group should perform can lead to standardisation and improved interdisciplinary management of CKD patients. Addressing patients' everyday knowledge systems can be valuable in formulating and prioritising health goals with patients. K E Y W O R D S chronic kidney disease, interdisciplinary care, nephrology care, primary secondary care interface, qualitative study | e439 HAASE Et Al.

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Chronic kidney disease in primary care in Germany

Cited by 15 publications

References 28 publications

Utilization of lipid-modifying therapy and low-density lipoprotein cholesterol goal attainment in patients at high and very-high cardiovascular risk: Real-world evidence from Germany

Utilization of lipid-modifying therapy and low-density lipoprotein cholesterol goal attainment in patients at high and very-high cardiovascular risk: Real-world evidence from Germany

High Unawareness of Chronic Kidney Disease in Germany

Nephrologists’ perspectives on ambulatory care of patients with non‐dialysis chronic kidney disease ‐ A qualitative study

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