The Underdiagnosis of Chronic Kidney Disease in Patients with a Documented Estimated Glomerular Filtration Rate and/or Urine Albumin–Creatinine Ratio in Germany
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MDPI
Abstract
Background and Objectives: The underdiagnosis of chronic kidney disease (CKD) is
a critical issue worldwide. This present study aimed to explore the CKD subpopulation
regarding underdiagnosed CKD in individuals with a pathological estimated glomerular
filtration rate (eGFR) and/or urine albumin–creatinine ratio (UACR) values in Germany.
Materials and Methods: This analysis used data from the IQVIATM Disease Analyzer database
and included adult outpatients with at least two pathological consecutive eGFR and/or
UACR values, documented at least 60 days apart between October 2018 and September 2023
in 758 general practices. According to the 2024 KDIGO clinical practical guidelines, CKD
was defined based on both eGFR and UACR values. UACR values were used when no
pathological eGFR values were documented. The main outcome of the study was the
proportion of patients with a documented CKD in the total population as well as in defined
subgroups. Results: A total of 113,996 CKD patients (mean age: 76.5 (SD: 10.1) years;
60.2% female; 71.5% with mildly to moderately, 21.1% with moderately to severely, and
4.6% with a severely decreased eGFR value; and 1.0% with end-stage kidney disease)
were available for analyses. CKD diagnosis was documented in 46.9% of CKD patients
and was more frequent in male than in female patients (53.3% versus 42.7%). The highest
proportion was observed in patients with heart failure (57.0%), followed by patients
with type 2 diabetes (52.7%). In patients without diabetes and heart failure, CKD was
documented in 38.2%. The proportion of CKD diagnoses increased with decreasing eGFR
values, from 22.0% in patients with nonpathological eGFR but moderately or severely
increased UACR to 87.7% in patients with end-stage kidney disease. Conclusions: The study
provides valuable insights into the subpopulation of underdiagnosed CKD patients among
a large patient population. These results underscore the need for improved screening,
timely diagnosis documentation, and treatment strategies for CKD, particularly among
high-risk populations. Moreover, it raises the need to increase awareness of micro- and
macroalbuminuria as diagnostic criteria for CKD independent of eGFR.
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