Kidney Week

Abstract: FR-PO369

Diagnosis of CKD in Patients with Hypertension in German Primary Care: The InspeCKD Study

Session Information

• Hypertension, CVD, and the Kidneys: Epidemiology
  October 25, 2024 | Location: Exhibit Hall, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Hypertension and CVD

• 1602 Hypertension and CVD: Clinical

Authors

• Wanner, Christoph, Department for Clinical Studies and Epidemiology, Comprehensive Heart Failure Center, University Clinic Würzburg, Würzburg, Germany

Christoph Wanner, MD

• Mader, Frederik Maria, Joint Practice Nittendorf, Nittendorf, Germany

Frederik Maria Mader, MD, PhD

• Frese, Thomas, Institute of General Medicine, Interdisciplinary Center for Health Sciences, Martin Luther University Halle-Wittenberg, Halle, Germany

Thomas Frese, MD, PhD

• Stahl, Philipp, Joint Family Practice Meinecke and Stahl, Burg, Germany

Philipp Stahl

• Weber, Christoph, Practice Rheinlanddamm, Dortmund, Germany

Christoph Weber, MD

• Opfermann, Ulrich, SYMEDICUM MVZ GmbH, Berlin, Germany

Ulrich Opfermann, MD

• Burckhardt, Fabian, BioPharmaceuticals Medical, AstraZeneca, Hamburg, Germany

Fabian Burckhardt, MD

• Scherg, Felix, BioPharmaceuticals Medical, AstraZeneca, Hamburg, Germany

Felix Scherg

• Radowsky, Frank, Family Practice Radowsky, Leipzig, Germany

Frank Radowsky, APN

• Schaeffner, Elke, Institute of Public Health, Charité - University Medicine Berlin, Berlin, Germany

Elke Schaeffner, MD, MS

Background

Hypertension (HT) is a known risk factor for chronic kidney disease (CKD) and a strong determinant of kidney and cardiovascular (CV) outcomes. Early diagnosis and therapy of CKD with organ protective treatments reduce the risks of kidney failure and CV complications. Therefore, assessment of kidney function by assessing eGFR and UACR in all patients with HT is recommended by the ESH 2023 and KDIGO 2024 guidelines.
To date, there is limited data on the frequency of screening, diagnosis, and guideline-directed medical therapy of CKD in HT patients in general practitioner (GP) practices. The InspeCKD study was designed to fill this gap.

Methods

1,244 GPs provided fully anonymized individual data sets for analysis. According to the KDIGO screening recommendation, adult patients with HT, diabetes and/or CV diseases with at least one year of observation period were included in the analysis. In this pre-specified sub-analysis, only HT patients were evaluated.

Results

A total of 448,837 patients were included in the study, of whom 75.8% had HT (53.6% female; median age 66 years).
Serum creatinine (SCr) to estimate eGFR (CKD EPI) was measured at least once in 43.4% of HT patients during the mean observation period of 1.7 years. Urine dipstick testing for albuminuria was performed at least once in 6.4% of HT patients and UACR was measured at least once in 0.3% of HT patients. 25.8% of HT patients had at least two SCr or UACR measurements at least three months apart to diagnose CKD. Among HT patients with laboratory confirmed CKD according to KDIGO (2x eGFR <60ml/min/1.73m^2 or 2x UACR >30mg/g in ≥3 months), 86.6% were not diagnosed with CKD.
Guideline-directed medical therapy for CKD, defined as combination therapy with RASi and SGLT2i, was administered in 8.2% of HT patients diagnosed with CKD.

Conclusion

The analysis demonstrates the inadequacy of laboratory diagnostics in the early detection of CKD in HT patients at risk for CKD, including those with type 2 diabetes. It also reveals substantial gaps in diagnosis and treatment initiation in a country with full healthcare coverage. It is therefore important to raise awareness among GPs for the early detection and treatment of CKD in HT patients.

Funding

• Commercial Support – AstraZeneca, Germany