Kidney360 · 2026
Prevalence of Undertreated CKD among Hospital Inpatients: A Prospective Cross-Sectional Study.
СтатьяНазвание и аннотация: Перевод в очереди
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Wynter Lucinda, Smyth Brendan, Saunders John, Moroney Carmen, Gorringe Lilijana, Turner Kylie, Venugopal Sreeram, Aouad Leyla, Tientstra Lisa, Monteverde Rowena, Kang Amy, Mangos George, Sen Shaundeep, Wyld Melanie, Norris Sarah, Chadban Steve
Аннотация
BACKGROUND: CKD affects 14% of adults in Australia and is frequently under-recognised or diagnosed in late stages when opportunities to prevent progression to kidney failure have been missed. Existing early identification programs target primary care or specific high-risk populations. Hospitalisation may present an opportunity to identify undertreated CKD. We hypothesise that there is a high prevalence of undertreated stage 3b-5 CKD among patients admitted to teaching hospitals in Sydney, Australia.
METHODS: We prospectively identified all adult patients with an eGFR < 45ml/min/1.73m2 admitted to hospital under a non-nephrology service, in six metropolitan hospitals from two health districts of Sydney, Australia, between March 2024-Feb 2025 inclusive. To identify those mostly likely to benefit from guideline directed medical therapy (GDMT) for CKD, we excluded those >80 years of age, pregnant, diagnosed with dementia, nursing home residents, who had a life-expectancy less than 2 years, or who had acute kidney injury. We extracted demographic, co-morbidity and medication data from the electronic medical record.
RESULTS: Among 77,447 patients, 11,243 (14.5%) had an eGFR < 45ml/min/1.73m2 on admission. After exclusions, 956 patients (1.2%) were included in the study. Median age was 75 years (IQR: 70,78), and participants had multiple co-morbidities including hypertension (78.1%), diabetes (40.7%), obesity (46.8%), coronary artery disease (34.6%) and heart failure (22.1%). CKD was documented in 24.2% and 5.8% had a urine albumin:creatinine (UACR) result available. Medications on admission included SGLT2 inhibitors (18.5%), renin-angiotensin blockers (52.1%), and statins (63.2%).
CONCLUSIONS: Hospital admission represents a unique opportunity to identify undiagnosed and/or undertreated patients with mid to late-stage CKD. Interventions designed to detect and better manage this population warrant further investigation.
METHODS: We prospectively identified all adult patients with an eGFR < 45ml/min/1.73m2 admitted to hospital under a non-nephrology service, in six metropolitan hospitals from two health districts of Sydney, Australia, between March 2024-Feb 2025 inclusive. To identify those mostly likely to benefit from guideline directed medical therapy (GDMT) for CKD, we excluded those >80 years of age, pregnant, diagnosed with dementia, nursing home residents, who had a life-expectancy less than 2 years, or who had acute kidney injury. We extracted demographic, co-morbidity and medication data from the electronic medical record.
RESULTS: Among 77,447 patients, 11,243 (14.5%) had an eGFR < 45ml/min/1.73m2 on admission. After exclusions, 956 patients (1.2%) were included in the study. Median age was 75 years (IQR: 70,78), and participants had multiple co-morbidities including hypertension (78.1%), diabetes (40.7%), obesity (46.8%), coronary artery disease (34.6%) and heart failure (22.1%). CKD was documented in 24.2% and 5.8% had a urine albumin:creatinine (UACR) result available. Medications on admission included SGLT2 inhibitors (18.5%), renin-angiotensin blockers (52.1%), and statins (63.2%).
CONCLUSIONS: Hospital admission represents a unique opportunity to identify undiagnosed and/or undertreated patients with mid to late-stage CKD. Interventions designed to detect and better manage this population warrant further investigation.