KNOWLEDGE AND APPLICATION OF THE 2021 SPANISH CONSENSUS DOCUMENT FOR THE DETECTION AND MANAGEMENT OF CHRONIC KIDNEY DISEASE FOR PRIMARY CARE PHYSICIANS (KGAP SURVEY).

By 2021, a joint statement from the American Society of Nephrology, European Renal Association, and International Society of Nephrology indicated that more than 850 million people suffer from some degree of kidney disease (1). In Spain, the prevalence of chronic kidney disease (CKD) is around 15% (2), similar to those found in other series (3) representing a public health issue. In our country, Primary Care Physicians (PCP) is the cornerstone of the public health system, playing a crucial role not only in the early detection of CKD but also in managing progression factors and complications, even at the early stages of the disease. Therefore, the Spanish Society of Nephrology, along with societies related to PCP (the Spanish Society of General Practitioners and Family Doctors (SEMG), Spanish Society of Primary Care Physicians (SEMERGEN), Spanish Society of Family and Community Medicine (SEMFyC), among others) has developed a national consensus document (4) that aims to simplify concepts regarding CKD approach and assistance in multidisciplinary patient management based on the knowledge and recommendations available at the time of its publication. However, despite the first Spanish consensus documents on CKD dating back to 2007, and the most recent one from 2021, there are no studies evaluating the knowledge, applicability, and real impact of these documents among PCP. Given the lack of previous references evaluating these aspects, we believe that feedback would be essential to determine whether the document meets its objectives and achieves expected outcomes. Additionally, we aim to evaluate the actual use of specific nephrology web mobile applications (app) to support PCP practice. These findings will allow us to establish hypotheses and propose improvement strategies.

We conducted a cross-sectional descriptive study based on the analysis of responses from a self-administered written survey applied to PCP (specialists and fellows) named KGAP Survey [Knowledge G-AP (AP: primary care physicians in spanish]) during the period from January to July 2023 from 4 Autonomous Communities (AC) in Spain: Castilla-La Mancha, Madrid, Extremadura, and Andalusia. We evaluated the degree of knowledge and applicability of the consensus document for CKD management in this population. The analysis of categorical variables was performed using percentages and mean with standard deviation (SD) for quantitative variables. When missing data were greater than 5% for a given variable, we used multiple imputation method (linear regression for quantitative variables and logistic regression for qualitative variables). Pooled results for each imputed variable were used for analysis. Contrast of hypotheses of categorical variables was carried out by chi-square test. We considered a statistically significant result a P<0.05. For statistical analysis, we used the SPSS v.23 software package.

After giving their written consent to participate, a total of 213 PCP (53.3% females) were surveyed during meetings and training courses in Castilla-La Mancha (42.7%), Extremadura (31%), Madrid (16.9%), and Andalusia (9.4%). The mean ± SD of age was 43.11±10.49 years, of which 80% were specialists and 20% fellows (table 1). A total of 35.5% PCP answered knowing the previous consensus document on CKD management from 2012, while 51.9% knew the recently published document in 2021 (figure 1). Of these, 80% were specialists, 20% fellows (figure 2), and 54% were over 40 years old (figure 3). Among AC, knowledge of the 2021 document was 39.8% in Castilla-La Mancha, 33.3% in Extremadura, 17.6% in Madrid, and 9.3% in Andalusia (figure 4). Of those who knew the 2021 document, 50.3% considered the presence of simple and concrete algorithms as the most favorable aspect, while 33.7% claimed poor dissemination of the information as the most unfavorable aspect of the document (figure 5AB). Only 32% of surveyed use an app to support management of CKD patients (notably, 80.9% specialists vs 19.1% fellows) (figure 6). The Spanish app Nefroconsultor® was the most used (65%) (table 1).