Prevalence of chronic kidney disease in the community using data from OxRen: a UK population-based cohort study

Abstract

BackgroundChronic kidney disease (CKD) is a largely asymptomatic condition of diminished renal function, which may not be detected until advanced stages without screening.AimTo establish undiagnosed and overall CKD prevalence using a cross-sectional analysis.Design and settingLongitudinal cohort study in UK primary care.MethodParticipants aged ≥60 years were invited to attend CKD screening visits to determine whether they had reduced renal function (estimated glomerular filtration rate [eGFR] <60 ml/min/1.73 m2 or albumin:creatinine ratio ≥3 mg/mmol). Those with existing CKD, low eGFR, evidence of albuminuria, or two positive screening tests attended a baseline assessment (CKD cohort).ResultsA total of 3207 participants were recruited and 861 attended the baseline assessment. The CKD cohort consisted of 327 people with existing CKD, 257 people with CKD diagnosed through screening (CKD prevalence of 18.2%, 95% confidence interval [CI] = 16.9 to 19.6), and 277 with borderline/transient decreased renal function. In the CKD cohort, 54.4% were female, mean standard deviation (SD) age was 74.0 (SD 6.9) years, and mean eGFR was 58.0 (SD 18.4) ml/min/1.73 m2. Of the 584 with confirmed CKD, 44.0% were diagnosed through screening. Over half of the CKD cohort (51.9%, 447/861) fell into CKD stages 3–5 at their baseline assessment, giving an overall prevalence of CKD stages 3–5 of 13.9% (95% CI = 12.8 to 15.1). More people had reduced eGFR using the Modification of Diet in Renal Disease (MDRD) equation than with CKD Epidemiology Collaboration (CKD-EPI) equation in the 60–75-year age group and more had reduced eGFR using CKD-EPI in the ≥80-year age group.ConclusionThis study found that around 44.0% of people living with CKD are undiagnosed without screening, and prevalence of CKD stages 1–5 was 18.2% in participants aged >60 years. Follow-up will provide data on annual incidence, rate of CKD progression, determinants of rapid progression, and predictors of cardiovascular events.

Prevalence and factors associated with multimorbidity among primary care patients with decreased renal function

“…Interested and potentially eligible participants attended a primary visit where the study was explained and written informed consent was obtained. All OxREN participants who had a baseline assessment (n = 861) were included in the analysis [ 27 ]. Non-fasting blood and urine samples collected at the baseline study visit were analysed within 24 hours across two laboratories using identical albumin-creatinine ratio (ACR) and isotope dilution mass spectrometry (IDMS)-traceable enzymatic creatinine assays, and reported using the Modification of Diet in Renal Disease (MDRD) eGFR.…”

“…The remaining 277 (32.2%) participants did not have a CKD diagnosis, but had one test with either a decreased eGFR (<60 ml/min/1.73m 2 ) or a raised urinary ACR (>3 mg/mmol), suggesting transiently impaired renal function, or may potentially arise from variability in analytical methods in those near diagnostic thresholds. More details of the population included in this analysis are given in our paper summarising the characteristics from the baseline study visit [ 28 ].…”

“…The study was established in 2013 in the central region of the southern United Kingdom. The objectives include defining the prevalence of selected risk factors for CKD and establishing the distribution of estimated kidney function and its trajectory over time in patients detected by a targeted screening programme [ 26 , 27 ]. Understanding the range of comorbidities and the most common combinations of comorbidities will help the on-going clinical management of this population and establish whether people with CKD have higher rates of multimorbidity compared with the general population.…”

How Do I Manage Hypertension in Patients with Advanced Chronic Kidney Disease Not on Dialysis? Perspectives from Clinical Practice

“…9 In a UK primary care cohort of patients older than 60 years and enriched with CKD patients, 23% of patients pertained to the stages 3b and 4 groups. 10 Patients with advanced CKD not on dialysis are at high or very high cardiovascular risk according to hypertension guidelines. 11 Indeed, the risk of myocardial infarction, heart failure, stroke or peripheral artery disease is significantly higher in patients with CKD than in the non-CKD population and, as expected, the cardiovascular risk rises further as kidney function declines.…”

Analysing the impact of a guideline for the use of new potassium binders for treatment of chronic hyperkalaemia to maximise inhibition of renin–angiotensin–aldosterone system (RAAS) within the general nephrology clinic?

“…Many patients with CKD receive suboptimal treatment due to di culties with regular monitoring or even because they are undiagnosed, given that CKD remains largely asymptomatic. Without regularly screening diminishing renal function may go undetected, leaving a signi cant percentage of the population with CKD undiagnosed [23]. This illustrates the potential wider reaching impact which these newer potassium binding agents can have in the management of these chronic conditions in primary care and within the community.…”