Prevalence and Demographics of CKD in Canadian Primary Care Practices: A Cross-sectional Study

Abstract

Introduction: Surveillance systems enable optimal care delivery and appropriate resource allocation, yet Canada lacks a dedicated surveillance system for chronic kidney disease (CKD). Using data from the Canadian Primary Care Sentinel Surveillance Network (CPCSSN), a national chronic disease surveillance system, this study describes the geographic, sociodemographic, and clinical variations in CKD prevalence in the Canadian primary care context. Methods: This cross-sectional study included 559,745 adults in primary care in 5 provinces across Canada from 2010 through 2015. Data were analyzed by geographic (urban or rural residence), sociodemographic (age, sex, deprivation index), and clinical (medications prescribed, comorbid conditions) factors, using data from CPCSSN and the Canadian Deprivation Index. CKD stage 3 or higher was defined as 2 estimated glomerular filtration rate (eGFR) values of <60 ml/min per 1.73 m 2 more than 90 days apart as of January 1, 2015. Results: Prevalence of CKD was 71.9 per 1000 individuals and varied by geography, with the highest prevalence in rural settings compared with urban settings (86.2 vs. 68.4 per 1000). CKD was highly prevalent among individuals with 3 or more other chronic diseases (281.7 per 1000). Period prevalence of CKD indicated a slight decline over the study duration, from 53.4 per 1000 in 2010 to 46.5 per 1000 in 2014. Conclusion: This is the first study to estimate the prevalence of CKD in primary care in Canada at a national level. Results may facilitate further research, prioritization of care, and quality improvement activities to identify gaps and improvement in CKD care.

Quality of Chronic Kidney Disease Management in Canadian Primary Care

“…This study builds on a previous study 39 that used data from CPCSSN to estimate the prevalence of CKD being managed in primary care practices across Canada. This current work provides an in-depth assessment of the current practice pattern and variations in care for CKD to understand areas of appropriate and inappropriate variation within the context of multimorbidity, patient-centered care, and primary care service delivery to support quality improvement that is most meaningful for patients.…”

Prevalence of chronic kidney disease and cardiovascular comorbidities in adults in First Nations communities in northwest Ontario: a retrospective observational study

“…Studies using data arising from patient care cohorts showed a higher prevalence of stage 3-5 disease (7%-8%). 14,24 Our methodology approximated that of a 2019 study of the prevalence of advanced chronic kidney disease in the general Canadian population, with electronic medical record data extraction from primary care practices. 24 Those authors used only estimated glomerular filtration rate results (no albumin:creatinine ratio), with findings equivalent to ours (prevalence of stage 3-5 disease of 7%).…”

“…14,24 Our methodology approximated that of a 2019 study of the prevalence of advanced chronic kidney disease in the general Canadian population, with electronic medical record data extraction from primary care practices. 24 Those authors used only estimated glomerular filtration rate results (no albumin:creatinine ratio), with findings equivalent to ours (prevalence of stage 3-5 disease of 7%). Similarly, in a study using data from health administrative databases from 1980-2005 (before the advent of the electronic medical record) in Saskatchewan, the prevalence of advanced disease was 8%.…”

Clinical Pharmacists in Chronic Care

“…The total cost of dialysis is mostly composed of the costs of the treatment itself (including disposables, machines, accommodation, electricity, water and human resources) and the costs of medications, transportation, complications, additional hospital admissions and interventions [331]. Total annual cost of CKD far exceeds $5 billion in Korea [332], $114 billion in US [327] and Canada $40 billion [333]. The prevalence of CKD and ESRD is projected to rise by up to 80% by 2020 due to ageing population and the rising prevalence of diabetes in Australia [334].…”