Prevalence and recognition of chronic kidney disease in Stockholm healthcare

Alessandro Gasparini, Marie Evans, Josef Coresh, Morgan Grams, Olof Norin, Abdul R. Qureshi, Björn Runesson, Peter Barany, Johan Ärnlöv, Tomas Jernberg, Björn Wettermark, Carl G. Elinder, Juan Jesüs Carrero

Research output: Contribution to journalArticle

Abstract

BACKGROUND: Chronic kidney disease (CKD) is common, but the frequency of albuminuria testing and referral to nephrology care has been difficult to measure. We here characterize CKD prevalence and recognition in a complete healthcare utilization cohort of the Stockholm region, in Sweden.

METHODS: We included all adult individuals (n = 1 128 058) with at least one outpatient measurement of IDMS-calibrated serum creatinine during 2006-11. Estimated glomerular filtration rate (eGFR) was calculated via the CKD-EPI equation and CKD was solely defined as eGFR <60 mL/min/1.73 m2. We also assessed the performance of diagnostic testing (albuminuria), nephrology consultations, and utilization of ICD-10 diagnoses.

RESULTS: A total of 68 894 individuals had CKD, with a crude CKD prevalence of 6.11% [95% confidence interval (CI): 6.07-6.16%] and a prevalence standardized to the European population of 5.38% (5.33-5.42%). CKD was more prevalent among the elderly (28% prevalence >75 years old), women (6.85 versus 5.24% in men), and individuals with diabetes (17%), hypertension (17%) or cardiovascular disease (31%). The frequency of albuminuria monitoring was low, with 38% of diabetics and 27% of CKD individuals undergoing albuminuria testing over 2 years. Twenty-three per cent of the 16 383 individuals satisfying selected KDIGO criteria for nephrology referral visited a nephrologist. Twelve per cent of CKD patients carried an ICD-10 diagnostic code of CKD.

CONCLUSIONS: An estimated 6% of the adult Stockholm population accessing healthcare has CKD, but the frequency of albuminuria testing, nephrology consultations and registration of CKD diagnoses was suboptimal despite universal care. Improving provider awareness and treatment of CKD could have a significant public health impact.

Original languageEnglish (US)
Pages (from-to)2086-2094
Number of pages9
JournalNephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association
Volume31
Issue number12
StatePublished - Dec 1 2016

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Chronic Renal Insufficiency
Delivery of Health Care
Albuminuria
Nephrology
Referral and Consultation
Glomerular Filtration Rate
International Classification of Diseases
Sweden
Creatinine
Outpatients
Cardiovascular Diseases
Public Health
Hypertension
Serum

Keywords

  • chronic renal failure
  • creatinine
  • nephrology
  • public health
  • referral

ASJC Scopus subject areas

  • Nephrology
  • Transplantation

Cite this

Prevalence and recognition of chronic kidney disease in Stockholm healthcare. / Gasparini, Alessandro; Evans, Marie; Coresh, Josef; Grams, Morgan; Norin, Olof; Qureshi, Abdul R.; Runesson, Björn; Barany, Peter; Ärnlöv, Johan; Jernberg, Tomas; Wettermark, Björn; Elinder, Carl G.; Carrero, Juan Jesüs.

In: Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association, Vol. 31, No. 12, 01.12.2016, p. 2086-2094.

Research output: Contribution to journalArticle

Gasparini, A, Evans, M, Coresh, J, Grams, M, Norin, O, Qureshi, AR, Runesson, B, Barany, P, Ärnlöv, J, Jernberg, T, Wettermark, B, Elinder, CG & Carrero, JJ 2016, 'Prevalence and recognition of chronic kidney disease in Stockholm healthcare', Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association, vol. 31, no. 12, pp. 2086-2094.
Gasparini, Alessandro ; Evans, Marie ; Coresh, Josef ; Grams, Morgan ; Norin, Olof ; Qureshi, Abdul R. ; Runesson, Björn ; Barany, Peter ; Ärnlöv, Johan ; Jernberg, Tomas ; Wettermark, Björn ; Elinder, Carl G. ; Carrero, Juan Jesüs. / Prevalence and recognition of chronic kidney disease in Stockholm healthcare. In: Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association. 2016 ; Vol. 31, No. 12. pp. 2086-2094.
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abstract = "BACKGROUND: Chronic kidney disease (CKD) is common, but the frequency of albuminuria testing and referral to nephrology care has been difficult to measure. We here characterize CKD prevalence and recognition in a complete healthcare utilization cohort of the Stockholm region, in Sweden.METHODS: We included all adult individuals (n = 1 128 058) with at least one outpatient measurement of IDMS-calibrated serum creatinine during 2006-11. Estimated glomerular filtration rate (eGFR) was calculated via the CKD-EPI equation and CKD was solely defined as eGFR <60 mL/min/1.73 m2. We also assessed the performance of diagnostic testing (albuminuria), nephrology consultations, and utilization of ICD-10 diagnoses.RESULTS: A total of 68 894 individuals had CKD, with a crude CKD prevalence of 6.11{\%} [95{\%} confidence interval (CI): 6.07-6.16{\%}] and a prevalence standardized to the European population of 5.38{\%} (5.33-5.42{\%}). CKD was more prevalent among the elderly (28{\%} prevalence >75 years old), women (6.85 versus 5.24{\%} in men), and individuals with diabetes (17{\%}), hypertension (17{\%}) or cardiovascular disease (31{\%}). The frequency of albuminuria monitoring was low, with 38{\%} of diabetics and 27{\%} of CKD individuals undergoing albuminuria testing over 2 years. Twenty-three per cent of the 16 383 individuals satisfying selected KDIGO criteria for nephrology referral visited a nephrologist. Twelve per cent of CKD patients carried an ICD-10 diagnostic code of CKD.CONCLUSIONS: An estimated 6{\%} of the adult Stockholm population accessing healthcare has CKD, but the frequency of albuminuria testing, nephrology consultations and registration of CKD diagnoses was suboptimal despite universal care. Improving provider awareness and treatment of CKD could have a significant public health impact.",
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AU - Evans, Marie

AU - Coresh, Josef

AU - Grams, Morgan

AU - Norin, Olof

AU - Qureshi, Abdul R.

AU - Runesson, Björn

AU - Barany, Peter

AU - Ärnlöv, Johan

AU - Jernberg, Tomas

AU - Wettermark, Björn

AU - Elinder, Carl G.

AU - Carrero, Juan Jesüs

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N2 - BACKGROUND: Chronic kidney disease (CKD) is common, but the frequency of albuminuria testing and referral to nephrology care has been difficult to measure. We here characterize CKD prevalence and recognition in a complete healthcare utilization cohort of the Stockholm region, in Sweden.METHODS: We included all adult individuals (n = 1 128 058) with at least one outpatient measurement of IDMS-calibrated serum creatinine during 2006-11. Estimated glomerular filtration rate (eGFR) was calculated via the CKD-EPI equation and CKD was solely defined as eGFR <60 mL/min/1.73 m2. We also assessed the performance of diagnostic testing (albuminuria), nephrology consultations, and utilization of ICD-10 diagnoses.RESULTS: A total of 68 894 individuals had CKD, with a crude CKD prevalence of 6.11% [95% confidence interval (CI): 6.07-6.16%] and a prevalence standardized to the European population of 5.38% (5.33-5.42%). CKD was more prevalent among the elderly (28% prevalence >75 years old), women (6.85 versus 5.24% in men), and individuals with diabetes (17%), hypertension (17%) or cardiovascular disease (31%). The frequency of albuminuria monitoring was low, with 38% of diabetics and 27% of CKD individuals undergoing albuminuria testing over 2 years. Twenty-three per cent of the 16 383 individuals satisfying selected KDIGO criteria for nephrology referral visited a nephrologist. Twelve per cent of CKD patients carried an ICD-10 diagnostic code of CKD.CONCLUSIONS: An estimated 6% of the adult Stockholm population accessing healthcare has CKD, but the frequency of albuminuria testing, nephrology consultations and registration of CKD diagnoses was suboptimal despite universal care. Improving provider awareness and treatment of CKD could have a significant public health impact.

AB - BACKGROUND: Chronic kidney disease (CKD) is common, but the frequency of albuminuria testing and referral to nephrology care has been difficult to measure. We here characterize CKD prevalence and recognition in a complete healthcare utilization cohort of the Stockholm region, in Sweden.METHODS: We included all adult individuals (n = 1 128 058) with at least one outpatient measurement of IDMS-calibrated serum creatinine during 2006-11. Estimated glomerular filtration rate (eGFR) was calculated via the CKD-EPI equation and CKD was solely defined as eGFR <60 mL/min/1.73 m2. We also assessed the performance of diagnostic testing (albuminuria), nephrology consultations, and utilization of ICD-10 diagnoses.RESULTS: A total of 68 894 individuals had CKD, with a crude CKD prevalence of 6.11% [95% confidence interval (CI): 6.07-6.16%] and a prevalence standardized to the European population of 5.38% (5.33-5.42%). CKD was more prevalent among the elderly (28% prevalence >75 years old), women (6.85 versus 5.24% in men), and individuals with diabetes (17%), hypertension (17%) or cardiovascular disease (31%). The frequency of albuminuria monitoring was low, with 38% of diabetics and 27% of CKD individuals undergoing albuminuria testing over 2 years. Twenty-three per cent of the 16 383 individuals satisfying selected KDIGO criteria for nephrology referral visited a nephrologist. Twelve per cent of CKD patients carried an ICD-10 diagnostic code of CKD.CONCLUSIONS: An estimated 6% of the adult Stockholm population accessing healthcare has CKD, but the frequency of albuminuria testing, nephrology consultations and registration of CKD diagnoses was suboptimal despite universal care. Improving provider awareness and treatment of CKD could have a significant public health impact.

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