Are there lost opportunities in chronic kidney disease? A region-wide cohort study

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Sundström, Johan,Professor,1971-Uppsala universitet,Klinisk epidemiologi,Univ New South Wales, George Inst Global Hlth, Sydney, NSW, Australia (author)

Are there lost opportunities in chronic kidney disease? A region-wide cohort study

Article/chapterEnglish2024

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BMJ Publishing Group Ltd,2024
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LIBRIS-ID:oai:DiVA.org:du-48394
https://urn.kb.se/resolve?urn=urn:nbn:se:du-48394URI
https://doi.org/10.1136/bmjopen-2023-074064DOI
https://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-527484URI
http://kipublications.ki.se/Default.aspx?queryparsed=id:155602207URI

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Language:English
Summary in:English

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OBJECTIVES: Identify the windows of opportunity for the diagnosis of chronic kidney disease (CKD) and the prevention of its adverse outcomes and quantify the potential population gains of such prevention.DESIGN AND SETTING: Observational, population-wide study of residents in the Stockholm and Skåne regions of Sweden between 1 January 2015 and 31 December 2020.PARTICIPANTS: All patients who did not yet have a diagnosis of CKD in healthcare but had CKD according to laboratory measurements of CKD biomarkers available in electronic health records.OUTCOME MEASURES: We assessed the proportions of the patient population that received a subsequent diagnosis of CKD in healthcare, that used guideline-directed pharmacological therapy (statins, renin-angiotensin aldosterone system inhibitors (RAASi) and/or sodium-glucose cotransporter-2 inhibitors (SGLT2i)) and that experienced adverse outcomes (all-cause mortality, cardiovascular mortality or major adverse cardiovascular events (MACE)). The potential to prevent adverse outcomes in CKD was assessed using simulations of guideline-directed pharmacological therapy in untreated subsets of the study population.RESULTS: We identified 99 382 patients with undiagnosed CKD during the study period. Only 33% of those received a subsequent diagnosis of CKD in healthcare after 5 years. The proportion that used statins or RAASi was of similar size to the proportion that didn't, regardless of how advanced their CKD was. The use of SGLT2i was negligible. In simulations of optimal treatment, 22% of the 21 870 deaths, 27% of the 14 310 cardiovascular deaths and 39% of the 22 224 MACE could have been avoided if every patient who did not use an indicated medication for their laboratory-confirmed CKD was treated with guideline-directed pharmacological therapy for CKD.CONCLUSIONS: While we noted underdiagnosis and undertreatment of CKD in this large contemporary population, we also identified a substantial realisable potential to improve CKD outcomes and reduce its burden by treating patients early with guideline-directed pharmacological therapy.

Subject headings and genre

MEDICIN OCH HÄLSOVETENSKAP Klinisk medicin Urologi och njurmedicin hsv//swe
MEDICAL AND HEALTH SCIENCES Clinical Medicine Urology and Nephrology hsv//eng
MEDICIN OCH HÄLSOVETENSKAP Hälsovetenskap Folkhälsovetenskap, global hälsa, socialmedicin och epidemiologi hsv//swe
MEDICAL AND HEALTH SCIENCES Health Sciences Public Health, Global Health, Social Medicine and Epidemiology hsv//eng
MEDICIN OCH HÄLSOVETENSKAP Klinisk medicin Kardiologi hsv//swe
MEDICAL AND HEALTH SCIENCES Clinical Medicine Cardiac and Cardiovascular Systems hsv//eng
adult nephrology
chronic renal failure
epidemiology

Added entries (persons, corporate bodies, meetings, titles ...)

Norhammar, AnnaKarolinska Institutet (author)
Karayiannides, SteliosKarolinska Institutet (author)
Bodegård, JohanAstraZeneca PLC, Oslo, Norway NO,AstraZeneca PLC, Cardiovasc Renal & Metab Med Dept, BioPharmaceut, Oslo, Norway. (author)
Gustafsson, StefanSence Research AB, Uppsala,Sence Res AB, Uppsala, Sweden. (author)
Cars, ThomasSence Research AB, Uppsala,Sence Res AB, Uppsala, Sweden. (author)
Eriksson Svensson, MariaUppsala universitet,Njurmedicin,Uppsala kliniska forskningscentrum (UCR)(Swepub:uu)marsv604 (author)
Ärnlöv, Johan,1970-Högskolan Dalarna,Medicinsk vetenskap,Karolinska Institutet, Stockholm,Karolinska Inst, Div Family Med, Dept Neurobiol Care Sci & Soc, Stockholm, Sweden.;Dalarna Univ, Sch Hlth & Social Studies, Falun, Dalarna, Sweden.(Swepub:du)jan (author)
Uppsala universitetKlinisk epidemiologi (creator_code:org_t)

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MEDICAL AND HEALTH SCIENCES: MEDICAL AND HEAL ...; and Clinical Medicin ...; and Urology and Neph ...

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