BEYOND THE GUIDELINES: IMPLEMENTATION OF THE “TREATMENT PILLARS” IN THE EARLY STAGES OF CKD WITHIN A STATEWIDE SCREENING AND FOLLOW-UP PROGRAM IN THE GENERAL POPULATION

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Abstract Title *

BEYOND THE GUIDELINES: IMPLEMENTATION OF THE “TREATMENT PILLARS” IN THE EARLY STAGES OF CKD WITHIN A STATEWIDE SCREENING AND FOLLOW-UP PROGRAM IN THE GENERAL POPULATION

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Co-author 1

Jose Manuel Arreola-Guerra dr.jmag@gmail.com Institute for Comprehensive Care of Kidney Diseases of the State of Aguascalientes Department of Research Aguascalientes Mexico *

Co-author 2

Andrea Garcia-Diaz diazandylucy@gmail.com Institute for Comprehensive Care of Kidney Diseases of the State of Aguascalientes Department of Early Detection Aguascalientes Mexico -

Co-author 3

Emerson Collazo-Guzman cojazzo@gmail.com Institute for Comprehensive Care of Kidney Diseases of the State of Aguascalientes Department of Early Detection Aguascalientes Mexico -

Co-author 4

Kevin Reyes Viramontes kevinreyes77v@gmail.com Institute for Comprehensive Care of Kidney Diseases of the State of Aguascalientes Department of Early Detection Aguscalientes Mexico -

Co-author 5

Katy-Valeria De Santiago Rodríguez katyvdsr@gmail.com Institute for Comprehensive Care of Kidney Diseases of the State of Aguascalientes Department of Research Aguascalientes Mexico -

Co-author 6

Co-author 7

Co-author 8

Co-author 9

Co-author 10

Co-author 11

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Co-author 14

Co-author 15

Introduction

Mexico is among the countries with the highest burden of chronic kidney disease (CKD) worldwide. This study describes the implementation of prescription practices and follow-up of CKD patients identified through a population-based screening program in the state of Aguascalientes.

Methods

A prospective, observational, descriptive cohort study was conducted including individuals diagnosed with CKD. The albumin-to-creatinine ratio (ACR) was assessed at diagnosis and at the last follow-up visit.

Results

Between January 2020 and November 2024, a total of 35,000 screening tests were performed; 225 individuals remained under follow-up at our center. Among them, 134 were younger than 18 years and 91 were adults; 29 had type 2 diabetes mellitus (T2DM) and 85 had systemic arterial hypertension. One hundred eighteen (52.4%) had CKD stage G1A2, 32 (14.2%) G2A2, and 30 (13.3%) stage G3. The median albuminuria was 66.7 mg/g (IQR 36–175), and the median estimated glomerular filtration rate (eGFR) was 97 (78–115) mL/min/1.73m². Two hundred four patients (90.6%) received either an angiotensin receptor blocker (ARB) and/or a sodium-glucose cotransporter-2 inhibitor (SGLT2i) (ARB: 83.5%, SGLT2i: 49.3%). The median follow-up period was 11.5 months (IQR 7.4–14.9). Albuminuria decreased by −199 mg/g (−275 to −123), representing a −45% reduction (−67.7 to −23.1). Eighty percent of patients improved their albuminuria stage, while the eGFR declined by an average of −4.1 mL/min/1.73m². Across all age groups, sexes, and comorbidity profiles, the reduction in albuminuria was statistically significant (Table 1).

VariablesACR beforeACR Afterp-valueACR Delta(95%CI)ACR Delta% (95%CI)

Group	Initial ACR mg/gr, m (IQR)	Final ACR mg/gr, m(IQR)	p-value	ACRDelta (95%CI)	%ACRDelta (95%CI)
Global	66.7 (36 – 175)	10.9 (5.9 – 33.9)	<0.01	-199(-275 to -123)	-45.4 (-67 to -23)
Age 0 - 17	72.4 (159.4 – 48.2)	16.4 (7.1 – 33.3)	<0.01	-188.4 (-281 to -73)	-47.8 (-81.5 to -14.1)
Age 18 - 39	49.3 (25.5 -479)	8.1 (3 – 56.8)	<0.01	-271.4 (-469 to -72.9)	-51.5 (-70.1 to -32.8)
Age 40 -55	37.5 (30 – 169.7)	9.7 (3 – 44.9)	<0.01	-143.8 (-276 to -11.5)	-11.2 (-86.1 to +63.6)
DM2/SAH/Obesity	57.8 (31.8 - 208)	12.4 (4.4 – 37)	<0.01	-232 (-377 to -87.7)	-26.5 (-74.5 to 21.4)
No Comorbidity	32.1 (16.8 - 120.3)	7.1 (3 – 19.2)	<0.01	-171.4 (-243 to -98.9)	-61.1 (- 71 to – 51.2)
Inicial ACR<200 mg/gr/	54.1 (41.6 - 87.8)	13.3 (5.8 – 31)	<0.01	-35.8 (-52.2 to -19.5)	-38.5 (-72.9 to -4.2)

Conclusion

In early CKD stages, the use of ARBs and SGLT2 inhibitors significantly reduces albuminuria across all age groups and comorbidity categories, supporting their implementation beyond guideline recommendations in population-based CKD screening programs.

Kewords