Suboptimal monitoring and management in patients with unrecorded stage 3 chronic kidney disease in real-world settings: Insights from REVEAL-CKD.

Autor: Tangri N; Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada., Alvarez CS; Cardiovascular, Renal and Metabolism Epidemiology, BioPharmaceuticals Medical, AstraZeneca, Gaithersburg, Maryland, USA., Arnold M; Real World Evidence Data & Analytics, BioPharmaceuticals Medical, AstraZeneca, Cambridge, UK., Barone S; Global Medical Affairs, BioPharmaceuticals Medical, AstraZeneca, Gaithersburg, Maryland, USA., Cebrián A; Primary Care Center Cartagena Casco, Cartagena, Murcia, Spain.; Biomedical Research Institute of Murcia (IMIB), Murcia, Spain., Chen H; Medical/Payer Evidence Statistics, BioPharmaceuticals Medical, AstraZeneca, Gaithersburg, Maryland, USA., De Nicola L; Department of Advanced Medical and Surgical Sciences, Nephrology and Dialysis Unit, University of Campania Luigi Vanvitelli, Naples, Italy., Järbrink K; Cardiovascular, Renal and Metabolism Evidence, BioPharmaceuticals Medical, AstraZeneca, Gothenburg, Sweden., Kanumilli N; Diabetes, Endocrinology and Metabolism Centre, Manchester University NHS Foundation Trust, Manchester, UK., Lim KS; General Practice, Mt Druitt Medical Centre, Mount Druitt, New South Wales, Australia., Moriyama T; Osaka University, Suita, Osaka, Japan., Pecoits Filho R; Arbor Research Collaborative for Health, Ann Arbor, Michigan, USA.; School of Medicine, Pontificia Universidade Catolica do Parana, Curitiba, Brazil., Ribeiro de Castro MC; Renal Transplant Unit, University of São Paulo School of Medicine, São Paulo, Brazil., Santamaria R; Department of Nephrology, Reina Sofia University Hospital, Maimonides Biomedical Research Institute of Cordoba (IMIBIC), University of Cordoba, Cordoba, Spain., Schneider MP; Department of Nephrology and Hypertension, University Hospital Erlangen, University of Erlangen-Nuremberg, Erlangen, Germany., Virgitti JB; Cabinet Médical, Orry-La-Ville, France., Kushner P; Clinical Professor of Family Medicine, Department of Family Medicine, University of California Irvine Medical Center, Orange, California, USA.
Jazyk: angličtina
Zdroj: European journal of clinical investigation [Eur J Clin Invest] 2024 Jul 18, pp. e14282. Date of Electronic Publication: 2024 Jul 18.
DOI: 10.1111/eci.14282
Abstrakt: Background: Clinical practice guidelines for patients with chronic kidney disease (CKD) recommend regular monitoring and management of kidney function and CKD risk factors. However, the majority of patients with stage 3 CKD lack a diagnosis code, and data on the implementation of these recommendations in the real world are limited.
Aim: To assess the implementation of guideline-directed monitoring and management practices in the real world in patients with stage 3 CKD without a recorded diagnosis code.
Methods: REVEAL-CKD (NCT04847531) is a multinational, observational study of patients with stage 3 CKD. Eligible patients had ≥2 consecutive estimated glomerular filtration rate (eGFR) measurements indicative of stage 3 CKD recorded >90 and ≤730 days apart, lacked an International Classification of Diseases 9/10 diagnosis code corresponding to CKD any time before and up to 6 months after the second eGFR measurement. Testing of key measures of care quality were assessed.
Results: The study included 435,971 patients from 9 countries. In all countries, the prevalence of urinary albumin-creatinine ratio and albuminuria testing was low. Angiotensin-converting enzyme inhibitor, angiotensin receptor blocker and statin prescriptions were highly variable, and sodium-glucose cotransporter-2 inhibitor prescriptions remained below 21%. Blood pressure measurements were recorded in 20.2%-89.9% of patients.
Conclusions: Overall, a large proportion of patients with evidence of stage 3 CKD did not receive recommended, guideline-directed monitoring and management. The variability in standard of care among countries demonstrates a clear opportunity to improve monitoring and management of these patients, most likely improving long-term outcomes.
(© 2024 The Author(s). European Journal of Clinical Investigation published by John Wiley & Sons Ltd on behalf of Stichting European Society for Clinical Investigation Journal Foundation.)
Databáze: MEDLINE
Externí odkaz: