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Characteristics, management and outcomes in patients with CKD in a healthcare region in Sweden: a population-based, observational study

OBJECTIVES: To describe chronic kidney disease (CKD) regarding treatment rates, comorbidities, usage of CKD International Classification of Diseases (ICD) diagnosis, mortality, hospitalisation, evaluate healthcare utilisation and screening for CKD in relation to new nationwide CKD guidelines. DESIGN...

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Autores principales: Agvall, Björn, Ashfaq, Awais, Bjurström, Karl, Etminani, Kobra, Friberg, Lovisa, Lidén, Johanna, Lingman, Markus
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10364177/
https://www.ncbi.nlm.nih.gov/pubmed/37479523
http://dx.doi.org/10.1136/bmjopen-2022-069313
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author Agvall, Björn
Ashfaq, Awais
Bjurström, Karl
Etminani, Kobra
Friberg, Lovisa
Lidén, Johanna
Lingman, Markus
author_facet Agvall, Björn
Ashfaq, Awais
Bjurström, Karl
Etminani, Kobra
Friberg, Lovisa
Lidén, Johanna
Lingman, Markus
author_sort Agvall, Björn
collection PubMed
description OBJECTIVES: To describe chronic kidney disease (CKD) regarding treatment rates, comorbidities, usage of CKD International Classification of Diseases (ICD) diagnosis, mortality, hospitalisation, evaluate healthcare utilisation and screening for CKD in relation to new nationwide CKD guidelines. DESIGN: Population-based observational study. SETTING: Healthcare registry data of patients in Southwest Sweden. PARTICIPANTS: A total cohort of 65 959 individuals aged >18 years of which 20 488 met the criteria for CKD (cohort 1) and 45 470 at risk of CKD (cohort 2). PRIMARY AND SECONDARY OUTCOME MEASURES: Data were analysed with regards to prevalence, screening rates of blood pressure, glucose, estimated glomerular filtration rate (eGFR), Urinary–albumin–creatinine ratio (UACR) and usage of ICD-codes for CKD. Mortality and hospitalisation were analysed with logistic regression models. RESULTS: Of the CKD cohort, 18% had CKD ICD-diagnosis and were followed annually for blood pressure (79%), glucose testing (76%), eGFR (65%), UACR (24%). UACR follow-up was two times as common in hypertensive and cardiovascular versus diabetes patients with CKD with a similar pattern in those at risk of CKD. Statin and renin–angiotensin–aldosterone inhibitor appeared in 34% and 43%, respectively. Mortality OR at CKD stage 5 was 1.23 (CI 0.68 to 0.87), diabetes 1.20 (CI 1.04 to 1.38), hypertension 1.63 (CI 1.42 to 1.88), atherosclerotic cardiovascular disease (ASCVD) 1.84 (CI 1.62 to 2.09) associated with highest mortality risk. Hospitalisation OR in CKD stage 5 was 1.96 (CI 1.40 to 2.76), diabetes 1.15 (CI 1.06 to 1.25), hypertension 1.23 (CI 1.13 to 1.33) and ASCVD 1.52 (CI 1.41 to 1.64). CONCLUSIONS: The gap between patients with CKD by definition versus those diagnosed as such was large. Compared with recommendations patients with CKD have suboptimal follow-up and treatment with renin–angiotensin–aldosterone system inhibitor and statins. Hypertension, diabetes and ASCVD were associated with increased mortality and hospitalisation. Improved screening and diagnosis of CKD, identification and management of risk factors and kidney protective treatment could affect clinical and economic outcomes.
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spelling pubmed-103641772023-07-25 Characteristics, management and outcomes in patients with CKD in a healthcare region in Sweden: a population-based, observational study Agvall, Björn Ashfaq, Awais Bjurström, Karl Etminani, Kobra Friberg, Lovisa Lidén, Johanna Lingman, Markus BMJ Open Renal Medicine OBJECTIVES: To describe chronic kidney disease (CKD) regarding treatment rates, comorbidities, usage of CKD International Classification of Diseases (ICD) diagnosis, mortality, hospitalisation, evaluate healthcare utilisation and screening for CKD in relation to new nationwide CKD guidelines. DESIGN: Population-based observational study. SETTING: Healthcare registry data of patients in Southwest Sweden. PARTICIPANTS: A total cohort of 65 959 individuals aged >18 years of which 20 488 met the criteria for CKD (cohort 1) and 45 470 at risk of CKD (cohort 2). PRIMARY AND SECONDARY OUTCOME MEASURES: Data were analysed with regards to prevalence, screening rates of blood pressure, glucose, estimated glomerular filtration rate (eGFR), Urinary–albumin–creatinine ratio (UACR) and usage of ICD-codes for CKD. Mortality and hospitalisation were analysed with logistic regression models. RESULTS: Of the CKD cohort, 18% had CKD ICD-diagnosis and were followed annually for blood pressure (79%), glucose testing (76%), eGFR (65%), UACR (24%). UACR follow-up was two times as common in hypertensive and cardiovascular versus diabetes patients with CKD with a similar pattern in those at risk of CKD. Statin and renin–angiotensin–aldosterone inhibitor appeared in 34% and 43%, respectively. Mortality OR at CKD stage 5 was 1.23 (CI 0.68 to 0.87), diabetes 1.20 (CI 1.04 to 1.38), hypertension 1.63 (CI 1.42 to 1.88), atherosclerotic cardiovascular disease (ASCVD) 1.84 (CI 1.62 to 2.09) associated with highest mortality risk. Hospitalisation OR in CKD stage 5 was 1.96 (CI 1.40 to 2.76), diabetes 1.15 (CI 1.06 to 1.25), hypertension 1.23 (CI 1.13 to 1.33) and ASCVD 1.52 (CI 1.41 to 1.64). CONCLUSIONS: The gap between patients with CKD by definition versus those diagnosed as such was large. Compared with recommendations patients with CKD have suboptimal follow-up and treatment with renin–angiotensin–aldosterone system inhibitor and statins. Hypertension, diabetes and ASCVD were associated with increased mortality and hospitalisation. Improved screening and diagnosis of CKD, identification and management of risk factors and kidney protective treatment could affect clinical and economic outcomes. BMJ Publishing Group 2023-07-21 /pmc/articles/PMC10364177/ /pubmed/37479523 http://dx.doi.org/10.1136/bmjopen-2022-069313 Text en © Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. https://creativecommons.org/licenses/by-nc/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ (https://creativecommons.org/licenses/by-nc/4.0/) .
spellingShingle Renal Medicine
Agvall, Björn
Ashfaq, Awais
Bjurström, Karl
Etminani, Kobra
Friberg, Lovisa
Lidén, Johanna
Lingman, Markus
Characteristics, management and outcomes in patients with CKD in a healthcare region in Sweden: a population-based, observational study
title Characteristics, management and outcomes in patients with CKD in a healthcare region in Sweden: a population-based, observational study
title_full Characteristics, management and outcomes in patients with CKD in a healthcare region in Sweden: a population-based, observational study
title_fullStr Characteristics, management and outcomes in patients with CKD in a healthcare region in Sweden: a population-based, observational study
title_full_unstemmed Characteristics, management and outcomes in patients with CKD in a healthcare region in Sweden: a population-based, observational study
title_short Characteristics, management and outcomes in patients with CKD in a healthcare region in Sweden: a population-based, observational study
title_sort characteristics, management and outcomes in patients with ckd in a healthcare region in sweden: a population-based, observational study
topic Renal Medicine
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10364177/
https://www.ncbi.nlm.nih.gov/pubmed/37479523
http://dx.doi.org/10.1136/bmjopen-2022-069313
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