The 2021 European Society of Cardiology Cardiovascular Disease Prevention Guidelines: adding albuminuria to the SCORE scale increases the prevalence of very high/high cardiovascular risk among patients with chronic kidney disease

Cebrián, Ana; Cervantes, C. Escobar; Aranda, Unai; Palacios, Beatriz; Capel, Margarita; Sicras, Antoni; Sicras, A; Hormigo, Antonio; Manito, Nicolás; Botana, Manuel; Alcázar, Roberto

doi:10.1093/ckj/sfac019

Cited by 10 publications

(7 citation statements)

References 11 publications

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“…This difference could be a consequence of conducting this research in a specialized teaching hospital, where adherence to institutional protocols and guidelines may be higher than in other health care institutions. Even so, as proteinuria is an important risk factor for worsening cardiovascular outcomes, the absence of this screening in about 50% of the participants should be viewed with concern [ 12 , 35 ]. It is well established that late diagnosis of CKD is associated with increased morbidity, mortality, and resource utilization [ 36 ].…”

Section: Discussionmentioning

confidence: 99%

A Cross-Sectional Study on the Prevalence and Risk Stratification of Chronic Kidney Disease in Cardiological Patients in São Paulo, Brazil

et al. 2023

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Chronic kidney disease (CKD) provides a worse prognosis for patients with heart disease. In Latin America, studies that analyzed the prevalence and risk stratification of CKD in this population are scarce. We aimed to evaluate CKD prevalence and risk categories in patients of a public referral cardiology hospital in São Paulo, Brazil. This was a cross-sectional study based on a laboratory database. Outpatient serum creatinine and proteinuria results performed between 1 January 2021 and 31 December 2021 were analyzed. CKD was defined by estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m2 and proteinuria, by the albumin/creatinine ratio in a spot urine sample (UACR) >30 mg/g. A total of 36,651 adults were identified with serum creatinine levels (median age 72.4 [IQR, 51.0–73.6] years, 51% male). Among them, 51.9% had UACR dosage (71.5% with UACR < 30 mg/g, 22.6%, between 30–300 mg/g, and 5.9% with UACR > 300 mg/g). The prevalence of CKD was 30.9% (15.3% stage 3a, 10.2% stage 3b, 3.6% stage 4, and 1.7% stage 5), and the distribution of patients in the risk categories of the disease was: 52.0% with low-risk, 23.5%, moderate risk, 13.0%, high risk, and 11.2%, very high. In an outpatient setting, the prevalence of CKD in cardiological patients was almost three times (31%) that of the general population; about half of the individuals evaluated (48%) were not screened for an important risk marker (proteinuria), and approximately a quarter of these patients (24%) were in the high or very high CKD risk categories.

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Section: Discussionmentioning

confidence: 99%

A Cross-Sectional Study on the Prevalence and Risk Stratification of Chronic Kidney Disease in Cardiological Patients in São Paulo, Brazil

et al. 2023

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“…Emphasizing early intervention's clinical advantages, KDIGO supports the prioritization of efforts to implement CKD screening(4). Meanwhile, the 2021 European Society of Cardiology (ESC) Guidelines recognize CKD as a signi cant cardiovascular risk factor, suggesting its evaluation in broader cardiovascular screening (17). They underline the value of albuminuria and low GFR results, which can inform strategies, especially with new treatments that reduce cardiovascular events and preserve kidney function (17).…”

Section: Discussionmentioning

confidence: 99%

“…Meanwhile, the 2021 European Society of Cardiology (ESC) Guidelines recognize CKD as a signi cant cardiovascular risk factor, suggesting its evaluation in broader cardiovascular screening (17). They underline the value of albuminuria and low GFR results, which can inform strategies, especially with new treatments that reduce cardiovascular events and preserve kidney function (17). Re ecting the ESC's stance, the European Renal Association now urges more proactive CKD screening in the wider population (18).…”

Section: Discussionmentioning

confidence: 99%

Patterns of Kidney Function and Risk Assessment in a Nationwide Laboratory Database: The Brazilian CHECK-CKD Study

Guedes,

Dias,

Réa

et al. 2023

Preprint

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Background Chronic kidney disease (CKD) is a global health problem with rising prevalence, morbidity, mortality, and associated costs. Early identification and risk stratification are key to preventing progression to kidney failure. However, there is a paucity of data on practice patterns of kidney function assessment to guide the development of improvement strategies, particularly in lower-income countries. Methods A retrospective observational analysis was conducted in a nationwide laboratory database in Brazil. We included all adult patients with at least one serum creatinine assessment between June 2018 and May 2021. Our primary objective was to determine the proportion of patients with estimated glomerular filtration rate (eGFR) evaluations accompanied by equivalents of urinary to creatinine ratio (eUCR) assessments within 12 months. Results Out of 4,5323,332 serum creatinine measurements, 42% lacked eUCR measurements within 12 months. Approximately 10.8% of tests suggested CKD, mostly at stage 3a. The proportion of serum creatinine exams paired with eUCR assessment varied according to the CKD stage. Internal Medicine, Cardiology, and Obstetrics/Gynecology were the specialties requesting most of the creatinine tests. Nephrology contributed with only 1.1% of serum creatinine requests for testing. Conclusion Our findings reveal that a significant proportion of individuals with a creatinine test lack an accompanying urinary eUCR in Brazil, contrary to the recommendations of the international guidelines. Non-Nephrologists perform most kidney function evaluations, even among patients with presumable advanced CKD. This highlights the urge to incorporate in clinical practice the early detection of CKD and to encourage more collaborative multidisciplinary care to improve CKD management.

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“…Albuminuria is a significant marker of CKD progression and is accepted as an independent CV risk factor 22‐24 . Although the link between poor CV outcomes and albuminuria is strong, the pathophysiology associated with diabetic proteinuria and worsening of CV outcomes is not well understood 22,25 .…”

Section: Albuminuriamentioning

confidence: 99%

Change in albuminuria as a surrogate endpoint for cardiovascular and renal outcomes in patients with diabetes

Palmer

2023

Diabetes Obesity Metabolism

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For the purpose of predicting clinical outcomes in patients with diabetes and chronic kidney disease, change in albuminuria is a good candidate to be a surrogate marker for future cardiovascular events and progression of kidney disease. Spot urine albumin/creatinine ratio is convenient and recognized as a viable alternative to 24‐h albumin, with some limitations. Although there is sufficient evidence to validate its use in clinical trials as a surrogate endpoint for renal outcomes, this is not yet the case for cardiovascular outcomes. While change in albuminuria as a primary or secondary endpoint is trial‐specific, its use should be encouraged, nonetheless.

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The 2021 European Society of Cardiology Cardiovascular Disease Prevention Guidelines: adding albuminuria to the SCORE scale increases the prevalence of very high/high cardiovascular risk among patients with chronic kidney disease

Cited by 10 publications

References 11 publications

A Cross-Sectional Study on the Prevalence and Risk Stratification of Chronic Kidney Disease in Cardiological Patients in São Paulo, Brazil

A Cross-Sectional Study on the Prevalence and Risk Stratification of Chronic Kidney Disease in Cardiological Patients in São Paulo, Brazil

Patterns of Kidney Function and Risk Assessment in a Nationwide Laboratory Database: The Brazilian CHECK-CKD Study

Change in albuminuria as a surrogate endpoint for cardiovascular and renal outcomes in patients with diabetes

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