Laboratory-Based Identification of CKD in Primary Care—Prevalence, Recognition, and Care Gaps (2010–2022), Findings from The VISTAKID study

 

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https://storage.unitedwebnetwork.com/files/1099/e3199a575fb002d7370d9de53203286c.pdf
Laboratory-Based Identification of CKD in Primary Care—Prevalence, Recognition, and Care Gaps (2010–2022), Findings from The VISTAKID study

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sadollah
abedini
sadollah abedini sadollah.abedini@siv.no Vestfold Hospital Trust Kidney disease Tønsberg Norway *
Thea Bjerkestrand Bøe Thea.Bjerkestrand.Boe@siv.no Vestfold Hospital Trust Kidney Disease Tønsberg Norway -
Thea Bjune theabg@me.com NA NA Tønsberg Norway -
Morten lindberg morten.lindberg@siv.no Vestfold Hopsital Trust Central laboratory Tønsberg Norway -
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Chronic kidney disease (CKD) is common but often unrecognized in primary care. We aimed to quantify the burden of CKD stages 3–5 detected through routine GP testing, compare characteristics of patients known vs unknown to nephrology, and estimate population prevalence to inform shared-care pathways.

We assembled a laboratory cohort of adults with GP-ordered serum creatinine tests in Vestfold (April 2010–January 2022; annual prevalence summarized for 2010–2021). Individuals with ≥1 eGFR <60 mL/min/1.73 m² were identified; CKD stages 3–5 were confirmed per KDIGO (≥2 eGFR <60 at least 90 days apart). Hospital registries classified patients as known CKD (diagnosed/followed by nephrology) or unknown CKD (no nephrology contact). We compared demographics, stage distribution, eGFR trajectories, and testing for CKD complications (acid–base, phosphate, iron status, proteinuria).

Of 18,355 individuals with ≥1 reduced eGFR, 13,480 met KDIGO criteria for CKD stages 3–5 (mean eGFR 48 mL/min/1.73 m²; mean age 77 years; 56% women). Of these, 1,952 (15%) were known to nephrology, leaving 11,528 (≈85%) without recorded diagnosis or follow-up. Disease severity differed by care group: stages 3b–5 accounted for 54% among known vs 28% among unknown patients. Testing patterns suggested underuse of key assessments in primary care—especially proteinuria and labs for metabolic acidosis, hyperphosphatemia, and iron deficiency—while these were more frequent in nephrology. The estimated point prevalence of CKD stages 3–5 in Vestfold was 3.7% during 2010–2022.

Most patients with laboratory-confirmed CKD stages 3–5 identified in primary care were unknown to nephrology, pointing to under-diagnosis and missed risk stratification. Limited proteinuria and complication testing contribute to delays in recognition and therapy. Implementation priorities include systematic albuminuria testing, simplified decision support for GPs, and specialist access (e-consults/virtual triage) to improve detection and management without overwhelming services.


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