ASSESSING CARDIOVASCULAR RISK AND THERAPEUTIC GAPS IN CHRONIC KIDNEY DISEASE: THE UC ODISEA PROJECT.

Chronic kidney disease (CKD) is a public health concern affecting approximately 10% of the global population and is associated with multiple cardiovascular and non-cardiovascular complications, as well as increased risks of death and hospitalization. The burden of CKD is rising and may become the fifth leading cause of death by 2040. In patients with CKD, therapies such as renin–angiotensin–aldosterone system inhibitors (RAASi), sodium–glucose cotransporter-2 inhibitors (SGLT2i), nonsteroidal mineralocorticoid receptor antagonists (nsMRA), and glucagon-like peptide-1 receptor agonists (GLP-1 RA) in diabetic kidney disease form part of the standard of care (SoC) aimed at reducing major cardiovascular and kidney outcomes.
This study evaluates the use of RAASi and SGLT2i, with or without nsMRA and GLP-1 RA, as components of SoC for CKD management according to cumulative cardiovascular risk burden, within a quality-improvement program for CKD care in primary care (PC).

We conducted a retrospective, cross-sectional observational study including adults with CKD followed in PC in the Talavera de la Reina health area (Spain), as part of the UC ODISEA project (Sentinel Unit for Optimization of CKD Diagnosis and Follow-up in Primary Care). Institutional review board approval was obtained. We examined associations between individual cardiovascular risk factors (CVRF)—age, sex, hypertension, diabetes, dyslipidemia, obesity, smoking, cardiovascular disease, and heart failure—and use of SoC therapy in CKD using chi-square tests, Student’s t tests, and binary logistic regression adjusted for covariates. Cumulative cardiovascular risk burden was calculated as the sum of present risk factors and categorized as low (0–2), moderate (3–5), and high (6–8). Two-sided p < 0.05 was considered statistically significant. Analyses were performed with IBM SPSS Statistics, version 22.

We analyzed 428 individuals (mean age 78.13 ± 12.88 years); 90.4% were ≥60 years, 51.6% ≥80 years, and 54.4% were women. Mean eGFR (CKD-EPI 2021) was 50.44 ± 20.22 mL/min/1.73 m² and median albumin-creatinine ratio (ACR) was 505.87 ± 567.17 mg/g. In total, 41.6% and 34.8% of patients had up to 3 and 4 CVRF, respectively. Most were classified as moderate risk (82.5%; 3–5 CVRF), followed by low risk (17.3%; 0–2 CVRF) and high risk (0.2%; ≥6 CVRF). Overall, 28.5% of patients were not receiving CKD SoC therapy.
There was no statistically significant association between the number of CVRF and SoC use (t test, p = 0.298). The proportions of patients not receiving SoC were 29.0%, 21.6%, and 100% in the low-, moderate-, and high-risk groups, respectively; despite an apparent trend toward lower SoC use with higher risk, the association was not statistically significant (χ², p = 0.104). In the adjusted logistic regression, patients with moderate cardiovascular risk had lower odds of receiving SoC compared with the low-risk group (OR 0.652; 95% CI 0.358–1.186), although this result was not statistically significant.

In this cohort, SoC therapy for CKD was underused despite substantial cardiovascular risk. Although not statistically significant, findings suggest that implementation of guideline-based SoC may not consistently align with cardiovascular risk stratification in routine primary care.